Breast Reconstruction With Subpectoral, Air-Filled Tissue Expander Following Nipple-Sparing Mastectomy: A Safe...

Compared with immediate implant-based reconstruction, staged reconstruction using tissue expanders has been reported to have decreased nipple and mastectomy flap necrosis. Immediate filling of the expander with saline can place unnecessary pressure on the mastectomy flaps, increasing the risk of ischemia. Tissue expanders come packaged pre-expanded with air. We propose using tissue expanders with factory air at the index surgery to optimize nipple positioning and decrease skin and nipple necrosis; this also allows the draping of redundant skin to prevent skin wrinkling and nipple retraction.  Methods: A single-center, retrospective, and single-surgeon cohort study of 53 patients (91 breasts) was performed. Patients included in the study underwent nipple-sparing mastectomy (NSM) followed by immediate two-staged implant-based breast reconstruction. Patient demographics and tissue expander-associated complications were abstracted from electronic medical records.

Of the 53 patients, the most frequent complication was wound dehiscence, occurring in three patients (5.7%). Less common, self-limited complications included one case of hematoma and one case of seroma (1.9% each). There was also one reported tissue expander infection (1.9%). There were no incidents of other postoperative complications of interest, such as skin flap necrosis, nipple necrosis, nipple-areola complex (NAC) malposition, tissue expander malposition, and adjuvant treatment delay.

Our results indicate subpectoral placement of tissue expanders, with the manufacturer's original air still intact, did not result in NAC or mastectomy flap necrosis in any patient. Additionally, there were no instances of NAC or tissue expander malpositioning, nor were there delays in preplanned adjuvant cancer treatment. Furthermore, the absence of complications specifically associated with air-based tissue expander placement underscores the safety of this technique and supports its continued clinical use.