Effect of intraoperative saline fill volume on perioperative outcomes in tissue expander breast reconstruction

Background: The effect of tissue expander saline fill volume on perioperative complications in breast reconstruction is unclear. The authors evaluated patients undergoing immediate breast reconstruction with tissue expanders with varying saline fill volumes to determine patient-, surgery-, and disease-related factors associated with complication risk. Methods: Patients who had undergone immediate tissue expander placement after skin-sparing mastectomy between June of 2002 and September of 2009 were evaluated retrospectively. Logistic regression models were used to identify factors having a significant effect on perioperative complications. Results: One hundred sixty-four patients were included in this study. The mean percentage intraoperative tissue expander saline fill volume was 68 percent. Larger saline fill volumes were associated with larger bra size, higher body mass index, T3/T4 stage, antibiotic use, modified radical mastectomy, axillary lymph node dissection, lack of serratus muscle coverage, and longer time to drain removal. Forty-seven patients (29 percent) experienced at least one perioperative complication. Patients experiencing complications had higher mean percentage saline fill volumes than those who did not (78 percent versus 64 percent; p = 0.025). In univariate analysis, longer time to drain removal, axillary lymph node dissection, modified radical mastectomy, and larger percentage saline fill volume were significantly associated with complications. For every 10 percent increase in saline fill volume, complication risk increased 1.15 times (p = 0.018). In multivariate analysis, longer time to drain removal and modified radical mastectomy were significant factors for complications; however, the effect of percent saline fill volume was not significant. Conclusion: A large tissue expander saline fill volume at the time of skin-sparing mastectomy is not independently associated with perioperative complications in patients undergoing immediate breast reconstruction, but it may contribute to complication risk.