Trends in Hospital Billing for Mastectomy and Breast Reconstruction Procedures from 2013 to 2020

Abstract

Background: There has been a greater focus in recent literature proposing air to be a superior medium to saline in tissue expanders. This study aims to review the literature and assess the quality of data on the efficacy and safety of air as an alternative medium to saline in tissue expanders, in the setting of post-mastectomy two-stage reconstruction. Methods: A systematic review regarding air inflation of tissue expanders were conducted using PubMed, Embase, Cochrane Library, and Web of Science. The methods followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three reviewers separately performed data extraction and comprehensive synthesis. Results: A total of 427 articles were identified in our search query, of which 12 met the inclusion criteria. Thee pertained to inflation with room air, and eight pertained to inflation with CO2 using the AeroForm device. There were comparable to decreased overall complication rates in the room air/CO2 cohort compared to saline, although statistical significance was only observed in one of five two-arm studies. Investigating specific complications in the five two-arm studies, significantly lower rates of skin flap necrosis were only observed in two CO2-based studies. Studies rarely discussed other safety profile concerns, such as the impacts of air travel, radiation planning, and air extravasation beyond descriptions of select patients within the cohort. Conclusion: There is insufficient evidence to suggest improved outcomes with room air inflation of tissue expanders. Further work is needed to fully characterize the benefits and safety profiles of air insufflation before being adopted into clinical practice.