I don’t do a lot of breast cancer reconstruction these days, but having a two stage reconstruction where you place a tissue expander, then gradually inflate it over the course of months, and then exchange it for the final implant is still a widely used technique. The question for this article is can you expand the expander with air and not saline?
In the past, saline was used for all tissue expanders. This study, in the June Aesthetic Surgery Journal “Post mastectomy Breast Reconstruction with Gas vs. Saline Tissue Expanders: Does the Fill Type Matter?” looked at the outcomes of breast reconstruction using the two different fillers.
Study:
- Metanalysis of 11 studies
- Complications similar, except the risk of infection/cellulitis/abscess was significantly lower int he gas cohort
- Complications: expander loss, expander exposure, infection, hematoma, seroma, capsular contracture, rupture, skin loss, nipple loss, wound opening.
- The time to the second stage reconstruction was faster for the gas tissue expander group
- Total time to full expansion was faster
- Cost analysis showed that the gas tissue expander use saved $2055 in overall healthcare costs (this includes the risk of infection)
- Surgical outcomes were similar, other than the gas tissue expanders having a significantly decreased risk of post op infection
In their analysis, they discuss AeroForm tissue expanders can go faster as they expand gradually multiple times a week, rather than saline injected tissue expanders which were expanded every other week with larger volumes each time. They also say the gas expansion helps keep the soft tissue thicker, with better vascularity and lower complications. And it does not require as many doctor office visits to do the expansion.
The challenges of AeroForm are that it can’t be used in those who need radiation. It has a larger metal reservoir that stores the compressed carbon dioxide. Unfortunately, the company that made Aeroform filed for bankruptcy and the device is no longer on the market.
My thoughts?
Interesting. This study was not associated with any companies. It seems to really support using air to fill expanders, whether it is the AeroForm auto release air or injecting room air.