From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center.
Plast Reconstr Surg. 2023 Oct 1;152(4S):25S-34S. doi: 10.1097/PRS.0000000000010478. Epub 2023 Sep 28.
One option to optimize prepectoral tissue expander fill volume while minimizing stress on mastectomy skin flaps is to use air as an initial fill medium, with subsequent exchange to saline during postoperative expansion. The authors compared complications and early patient-reported outcomes (PROs) based on fill type in prepectoral breast reconstruction patients.
Prepectoral breast reconstruction patients who underwent intraoperative tissue expansion with air or saline from 2018 to 2020 were reviewed to assess fill-type utilization. The primary endpoint was expander loss; secondary endpoints included seroma, hematoma, infection/cellulitis, full-thickness mastectomy skin flap necrosis requiring revision, expander exposure, and capsular contracture. PROs were assessed with the BREAST-Q Physical Well-Being of the Chest scale 2 weeks postoperatively. Propensity-matching was performed as a secondary analysis.
Of 560 patients (928 expanders) included in the analysis, 372 had devices initially filled with air (623 expanders), and 188 with saline (305 expanders). No differences were observed for overall rates of expander loss (4.7% versus 3.0%, P = 0.290) or overall complications (22.5% versus 17.7%, P = 0.103). No difference in BREAST-Q scores was observed ( P = 0.142). Utilization of air-filled expanders decreased substantially over the last study year. After propensity matching, no differences in loss, other complications, or PROs were observed across cohorts.
Tissue expanders initially filled with air seem to have no significant advantage over saline-filled expanders in maintaining mastectomy skin flap viability or PROs, including after propensity matching. These findings can help guide choice of initial tissue expander fill type.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
在优化胸肌前置组织扩张器填充体积的同时，最小化乳房切除术皮瓣的压力的一种选择是使用空气作为初始填充介质，然后在术后扩张期间将其交换为盐水。作者比较了基于填充类型的胸肌前置乳房重建患者的并发症和早期患者报告结果（PROs）。
回顾了 2018 年至 2020 年间接受术中组织扩张的胸肌前置乳房重建患者，以评估填充类型的利用情况。主要终点是扩张器丢失；次要终点包括血清肿、血肿、感染/蜂窝织炎、需要 revision 的全层乳房切除术皮瓣坏死、扩张器暴露和包膜挛缩。术后 2 周使用 BREAST-Q 胸部物理健康量表评估 PROs。作为二次分析进行了倾向评分匹配。
在分析中纳入的 560 名患者（928 个扩张器）中，372 名患者的器械最初填充空气（623 个扩张器），188 名患者填充盐水（305 个扩张器）。扩张器丢失的总发生率（4.7%对 3.0%，P=0.290）或总体并发症发生率（22.5%对 17.7%，P=0.103）无差异。BREAST-Q 评分无差异（P=0.142）。空气填充扩张器的使用在研究最后一年大幅减少。在倾向评分匹配后，两个队列在丢失、其他并发症或 PROs 方面均无差异。
与盐水填充扩张器相比，最初填充空气的组织扩张器在维持乳房切除术皮瓣活力或 PROs 方面似乎没有明显优势，包括在倾向评分匹配后。这些发现可以帮助指导初始组织扩张器填充类型的选择。
临床问题/证据水平：治疗性，III 级。
