Shaheen Mohammed, Goli Rachna, Yesantharao Pooja, Arquette Connor, Makarewicz Nathan, Nazerali Rahim S
Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California.
Division of Plastic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Eplasty. 2024 Oct 23;24:e58. eCollection 2024.
Intraoperative expansion with air, as compared with saline, has been associated with fewer first-stage complications in 2-stage expander-implant breast reconstruction. However, longitudinal reconstructive outcomes, postoperative medication use indicating pain or discomfort, as well as patient-reported outcome measures after intraoperative air versus saline fill have not yet been investigated.
This is a retrospective cohort investigation of 69 patients who underwent 2-stage expander-implant prepectoral breast reconstruction with acellular dermal matrix in 2017 and 2018. Patients underwent intraoperative tissue expander (TE) fill with air or saline during stage 1 of reconstruction and underwent expander-implant exchange in stage 2. Air versus saline cohorts were compared with regards to time to definitive reconstruction and postoperative pain/opioid use.
Of the 69 patients studied, 47 (68.1%) had tissue expanders filled with air and 22 (31.9%) filled with saline. In multivariable regression analysis, air-filled TEs were associated with significantly lower odds of requiring an opioid prescription refill (adjusted odds ratio [aOR] = 0.27; = .009) and breast pain (aOR = 0.10; < .001). The use of air instead of saline TEs also had no adverse impact on the length of time or number of office visits between stages.
Intraoperative air versus saline TE fill appears to impact longitudinal reconstructive outcomes in expander-implant based reconstruction. Our results demonstrated that air-filled TEs were associated with significantly lower odds of opioid refills and breast pain. Our study also indicates that timing and office visits between stages do not appear to be affected by TE fill medium.
在两阶段扩张器-植入物乳房重建术中，与生理盐水相比，术中使用空气扩张与较少的一期并发症相关。然而，术中使用空气与生理盐水填充后的纵向重建结果、表明疼痛或不适的术后药物使用情况以及患者报告的结局指标尚未得到研究。
这是一项对2017年和2018年接受两阶段扩张器-植入物胸前置乳房重建并使用脱细胞真皮基质的69例患者的回顾性队列研究。患者在重建的第一阶段术中对组织扩张器（TE）进行空气或生理盐水填充，并在第二阶段进行扩张器-植入物置换。比较空气填充组和生理盐水填充组在确定性重建时间和术后疼痛/阿片类药物使用方面的情况。
在研究的69例患者中，47例（68.1%）的组织扩张器填充空气，22例（31.9%）填充生理盐水。在多变量回归分析中，空气填充的TEs与需要补充阿片类药物处方的几率显著降低（调整后的优势比[aOR]=0.27；P=.009）以及乳房疼痛（aOR=0.10；P<.001）相关。使用空气而非生理盐水填充的TEs对两个阶段之间的时间长度或门诊就诊次数也没有不利影响。
术中空气与生理盐水填充TEs似乎会影响基于扩张器-植入物的重建的纵向重建结果。我们的结果表明，空气填充的TEs与补充阿片类药物和乳房疼痛的几率显著降低相关。我们的研究还表明，两个阶段之间的时间安排和门诊就诊似乎不受TE填充介质的影响。
