Finding the Right Fill: The Ideal Tissue Expander Fill in Immediate Prepectoral Breast Reconstruction

Area of Science:

• Plastic Surgery
• Breast Reconstruction
• Oncology

Background:

• Prepectoral breast reconstruction is a common procedure.
• Factors influencing outcomes include mastectomy weight and flap quality.
• Intraoperative tissue expander (TE) fill is an adjustable factor.

Purpose of the Study:

• To assess the impact of intraoperative TE fill on postoperative complications in prepectoral breast reconstruction.
• To determine the optimal intraoperative TE fill to minimize complications.

Main Methods:

• Retrospective review of 200 patients undergoing prepectoral TE reconstruction (March 2017-December 2022).
• Calculation of a fill ratio (intraoperative TE fill to mastectomy weight) to quantify deadspace.
• Analysis of major complications (readmission/reoperation) and minor complications (outpatient treatment).

Main Results:

• Higher intraoperative TE fill and reduced deadspace were linked to increased major complications (P < 0.05).
• A higher fill ratio correlated with 2.4 times greater odds of major complications (P = 0.01).
• Optimal intraoperative TE fill for avoiding major complications was 80 cc (fill ratio ~0.09); for avoiding explantation, it was 80 cc (fill ratio ~0.12).

Conclusions:

• Increased intraoperative TE fill and decreased deadspace are associated with higher postoperative complication rates.
• Filling the TE to 80 cc, approximately 10% of mastectomy weight, may reduce complications in prepectoral breast reconstruction.