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Related Experiment Video

Updated: Aug 6, 2025

Quantification of Strain in a Porcine Model of Skin Expansion Using Multi-View Stereo and Isogeometric Kinematics
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Are Large Intraoperative Fill Volumes Associated With Increased Complications After Tissue Expander Placement?

Nikita Kadakia1, Austin R Swisher2, Priya G Lewis1

  • 1Department of Plastic Surgery, Loma Linda University Health, Loma Linda, CA.

Eplasty
|March 15, 2023
PubMed
Summary

Higher intraoperative tissue expander fill volumes (over 350 mL) in breast reconstruction are not linked to increased skin necrosis or other complications. This finding supports using larger fill volumes for better aesthetic outcomes in select patients.

Keywords:
Breast ReconstructionIntraoperative FillTissue ExpanderVolume

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Area of Science:

  • Plastic Surgery
  • Oncology
  • Breast Reconstruction

Background:

  • Immediate 2-stage breast reconstruction is common after skin-sparing mastectomies.
  • Higher intraoperative fill during tissue expander placement is a potential risk factor for complications.
  • Postoperative outcomes of higher intraoperative fill volumes require further investigation.

Purpose of the Study:

  • To evaluate if higher initial intraoperative tissue expander fill volume is associated with increased complication rates.
  • To assess the impact of large intraoperative fill volumes on skin/nipple necrosis and other complications.

Main Methods:

  • Retrospective review of patients undergoing immediate breast reconstruction with tissue expander placement (2016-2018).
  • Large intraoperative fill defined as saline fill volume > 350 mL.
  • Primary outcome: skin and nipple necrosis; Secondary outcomes: infections, seroma, hematoma.

Main Results:

  • 147 breasts in 86 patients included; mean fill 246.4 ± 106.6 mL; 35 had fill > 350 mL.
  • Patients with large fill were older, had higher BMI, and larger preoperative breast size.
  • Large fill volume was not a significant predictor of skin/nipple necrosis (P=.62) or other complications.

Conclusions:

  • Larger intraoperative fill volumes (>350 mL) were not associated with increased postoperative complications in this patient cohort.
  • Larger fill volumes can benefit patients with higher BMI or larger bra sizes, reducing postoperative fills.
  • Careful patient selection and perfusion evaluation allow for safe consideration of larger fill volumes to enhance aesthetic outcomes.