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Optimizing Staged Implant Based Breast Reconstruction with Air Filled Expanders to Reduce Pressure on Mastectomy Flaps, and Maintain Light Implant Expander Centralized Under Nipple Areola Complex with
Alexander T Nixon, MD
Bradon J Wilhelmi, MD
University of Louisville
2022-01-14
Presenter: Joshua MacDavid
Affidavit:
This is the original work of presenting fellow and respective coauthors.
Director Name: Bradon J Wilhelmi, MD
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction: 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 put unnecessary pressure on the mastectomy flaps, increasing 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 draping of redundant skin to prevent skin wrinkling and nipple retraction.
Study Design: A three-tab, textured tissue expander with integrated port is placed subpectorally; factory air is maintained. The pectoralis is draped over the expander and held in place with running suture; this prevents "window shading," and allows the mastectomy skin flap to heal to underlying muscle with an appropriately positioned nipple and expander port.
Results: In our review of over 100 two stage breast reconstructions, initially with factory air in subpectoral expanders, none of our patients had loss of mastectomy skin or nipple.
Conclusion: Employing this technique, maintaining the tissue expander with its factory air, is lighter and places less pressure on the mastectomy skin flaps, decreasing the risk of necrosis. Air maintains an even distribution throughout the expander and improves nipple positioning. The patient is left with a breast mound at the time of mastectomy which is light, and less traumatic to the skin flaps. Skin is smoothly draped over the air-filled expander, providing more acceptable initial results, and easier secondary pocket development.
