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Filling The Tissue Expander With Room Air: Can It Replace Saline?
Melody Bedrossian, B.S., Som Kohanzadeh, MD, Cristiano Boneti, MD.
Cancer Institute of America, Los Angeles, CA, USA.

PURPOSE: Two-stage saline tissue expander-to-implant procedure is the most commonly used breast reconstruction method in the United States. Standard approach in expanding the tissue expander (TE) is by using saline. The objective of this study was to determine the feasibility and volume retention over time of intraoperative TE expansion with room air.
METHODS: 119 patients were reviewed and a single institution retrospective chart review was performed. Patients, who received breast reconstruction with two-stage tissue expander-to-implant procedure between 2016 and 2017, were included in the study. Outcomes were compared between cases in which saline and room air were used in expanding TE.
RESULTS: Room air was used in expanding forty TE's in twenty-four patients. Although cases expanded with air had a higher complication rate of 17% vs. 12% with saline, this was not statistically significant (p=0.235). Obesity (BMI > 30 kg/m2) increased infection rate by 10-fold in the overall cohort (12% vs. 1%, p=0.014 OR 10.8 [1.08-108.39]). Average percentage of volume loss in air expansion cases was 53%. Average air volume loss per week was 38 cc 18.26 [8-90].
CONCLUSION: Expanding commercially available TE using room air reduces costs and operative time with similar complication rates. However, volume loss is predictable and should be considered during the expansion process. Obesity was the most significant patient factor associated with complications.


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