Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA.
Calc LLC, Wilton, CT, USA.
Ann Surg Oncol. 2023 Oct;30(11):6545-6553. doi: 10.1245/s10434-023-13763-2. Epub 2023 Jun 17.
Tissue expander fill medium and volume have implications for the pressure exerted on mastectomy skin flaps. This study evaluated the influence of initial fill medium (air vs. saline) on complications in immediate breast reconstruction within a propensity score-matched cohort.
Patients undergoing immediate tissue expander-based breast reconstruction with initial intraoperative fill with air were propensity score matched 1:2 to those with saline initial fill based on patient and tissue expander characteristics. Incidence of overall and ischemic complications were compared by fill medium (air vs. saline).
A total of 584 patients were included, including 130 (22.2%) with initial fill with air, 377 (64.6%) with initial fill with saline, and 77 (13.2%) with 0 cc of initial fill. After multivariate adjustment, higher intraoperative fill volume was associated with increased risk of mastectomy skin flap necrosis [regression coefficient (RC) 15.7; p = 0.049]. Propensity score matching was then conducted among 360 patients (Air: 120 patients vs. Saline: 240 patients). After propensity score matching, there were no significant differences in the incidences of mastectomy skin flap necrosis, extrusion, reoperation, or readmission between the air and saline cohorts (all p > 0.05). However, initial fill with air was associated with lower incidence of infection requiring oral antibiotics (p = 0.003), seroma (p = 0.004), and nipple necrosis (p = 0.03).
Within a propensity score-matched cohort, initial fill with air was associated with a lower incidence of complications, including ischemic complications after nipple-sparing mastectomy. Initial fill with air and lower fill volumes may be strategies to reducing risk of ischemic complications among high-risk patients.
组织扩张器填充介质和体积对乳房切除术皮瓣所受压力有影响。本研究通过倾向评分匹配队列评估初始填充介质（空气与盐水）对即刻乳房重建中并发症的影响。
将接受即刻基于组织扩张器的乳房重建并在术中初始填充空气的患者与基于患者和组织扩张器特征按 1:2 进行倾向评分匹配，初始填充盐水的患者。通过填充介质（空气与盐水）比较总体和缺血性并发症的发生率。
共纳入 584 例患者，其中 130 例（22.2%）初始填充空气，377 例（64.6%）初始填充盐水，77 例（13.2%）初始填充 0 cc。经过多变量调整，术中填充量较高与乳房切除术皮瓣坏死风险增加相关[回归系数（RC）15.7；p = 0.049]。然后在 360 例患者中进行倾向评分匹配（空气：120 例；盐水：240 例）。在进行倾向评分匹配后，空气组与盐水组之间在乳房切除术皮瓣坏死、挤出、再次手术或再入院的发生率方面无显著差异（均 p > 0.05）。然而，空气初始填充与需要口服抗生素的感染发生率较低相关（p = 0.003）、血清肿（p = 0.004）和乳头坏死（p = 0.03）。
在倾向评分匹配队列中，空气初始填充与并发症发生率较低相关，包括保留乳头乳房切除术的缺血性并发症。空气初始填充和较低的填充量可能是降低高危患者缺血性并发症风险的策略。
