Advances in Tissue Expander Technology Enable Early Targeted Intervention in Prepectoral Breast Reconstruction

Abstract

Background: Seroma and infection are among the most common complications after staged prepectoral implant-based reconstruction. Advances in tissue expander technology permit seroma aspiration via an integrated drain port, thus, holding promise for improving clinical outcomes. Methods: A prospectively maintained database of patients who had undergone immediate prepectoral breast reconstruction using the Sientra AlloX2 tissue expander was used to determine the rate of postoperative seroma formation, its volume and microbiological spectrum, as well as postoperative complications. Results: 49 patients (mean age: 49 years, mean body mass index: 24.5 kg/m 2 ) underwent 79 prepectoral breast reconstructions. Seroma was clinically suspected in 26 reconstructions (32.9%) and was easily aspirated in all cases via the integrated drain port. Importantly, periprosthetic fluid was successfully aspirated in 45 reconstructions (57%) without any clinical evidence for seroma, with aspirated cumulative fluid volumes exceeding 10 cm 3 in 12 reconstructions. Bacterial cultures from aspirated fluid were positive in six patients (12.2%), of whom two developed clinical signs of infection, at which point targeted antibiotic treatment was initiated. Conclusions: Our study demonstrates that routine office-based aspiration of periprosthetic fluid via the integrated drain port of the AlloX2 tissue expander not only permits successful aspiration of periprosthetic fluid but also allows aspirated fluid to be sent for culture, thus, providing a lead-time advantage for initiation of targeted antibiotic therapy in cases of postoperative surgical site infection. Furthermore, our observations indicate that positive bacterial cultures in the absence of clinical signs of infection do not mandate antibiotic therapy.

Pre-pectoral Breast Reconstruction: Surgical and Patient-Reported Outcomes of Two-Stages vs Single-Stage Implant-Based Breast Reconstruction

“…Despite the known usefulness of ADM, there are also some critical issues associated with their use, among them a potential increase in the likelihood of postoperative complications, mainly seroma and infection, with results appearing disparate and not always concordant in the literature. Therefore, ADMs are expensive and if not used appropriately may present difficulties in integrating into the host tissue, with the aforementioned complications [ 26 ].…”

Mycobacterium goodiiinfection associated with bilateral breast tissue expanders

“…Cultures were taken pre-emptively in this setting. This protocol is used commonly in patients undergoing pre-pectoral breast reconstruction and is standard practice by the patient’s plastic surgeon 1. She did not have any symptoms of infection at the time of culture collection.…”

“…Due to the rarity of this infection, the optimal treatment regimen, duration and timing of reimplantation of implants are unknown. Routine sampling of aspirate ports is commonly used as a means of early identification of involved organisms in case of infection development, potentially decreasing complications, such as failure of reconstruction 1. To our knowledge, no other M. goodii breast expander infection has been reported.…”

Toward Drainless Breast Reconstruction: A Pilot Study

“…The innovative design of this expander has been identified by other groups, proving the utility of this device. 7 , 8 Expanding upon the Ziedler study, Franck et al utilized dual-port expanders, comparing a cohort with and without drains to show the feasibility of the technique, but did not have patient-reported outcomes. 9 …”

“…The innovative design of this expander has been identified by other groups, proving the utility of this device. 7,8 Expanding upon the Ziedler study, Franck et al utilized dual-port expanders, comparing a cohort with and without drains to show the feasibility of the technique, but did not have patient-reported outcomes. 9 In an effort to demonstrate the feasibility of avoiding drains with this new type of tissue expander, along with an emphasis on patient satisfaction, we conducted a pilot study with five consecutive patients.…”