Hyperbaric Oxygen Therapy in Immediate Tissue Expander-Based Breast Reconstruction

Background Prepectoral tissue expander (TE) placement is an increasingly used breast reconstruction technique but may have a higher risk for mastectomy skin flap ischemia compared to subpectoral TE placement. Hyperbaric oxygen therapy (HBOT) has been shown to salvage compromised mastectomy skin flaps, but there is limited evidence on which patients require HBOT and benefit most from this treatment. Methods We retrospectively reviewed patients undergoing immediate TE breast reconstruction over a 6-year period. Patient demographics, intraoperative data, HBOT treatment, complications, and final breast reconstruction type were collected. Analyses were performed by patient and by breast. Results Among 348 patients (552 breasts), 299 (86%) patients (477 breasts) had prepectoral and 49 (14%) patients (75 breasts) had subpectoral TE placement. Only prepectoral patients received HBOT (19 patients/33 breasts vs 0 patients/breasts, P = 0.037). Breasts receiving HBOT had higher rates of mastectomy skin necrosis (30-day: 73% vs 5.6%, P < 0.001; 90-day: 76% vs 6.5%, P < 0.001), returns to the OR for necrosis excision (30-day: 18% vs 3.2%, P = 0.001; 90-day: 21% vs 5.4%, P = 0.003), and TE explantation (30-day: 21% vs 1.8%, P < 0.001; 90-day: 24% vs 3.8%, P < 0.00001) at the 30- and 90-day postoperative periods. However, these rates did not significantly increase from 30 to 90 days. For those with mastectomy skin necrosis, HBOT salvaged significantly more mastectomy pockets (76% vs 41%, P < 0.0001). Conclusions Patients with prepectoral TE placement were significantly more likely to receive HBOT. Compared to no treatment, HBOT was able to salvage almost twice as many mastectomy pockets, providing valuable information for mastectomy skin flap ischemia treatment options.