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Delayed inflation of Biocell expander implant after insertion may be beneficial

Delaying the first postoperative saline inflation of a Biocell expander implant until 6 weeks postoperatively allowed for capsule maturation and could help optimize the implant’s ability to accommodate capsular adherence, according to study findings.

Forty-eight patients with breast cancer scheduled to undergo two-stage implant-based reconstruction were prospectively enrolled in the study prior to second-stage expander-to permanent implant exchange.

M. Alain Danino

The researchers collected baseline demographic and medical chart data for each of the patients, documenting variables such as type of mastectomy, the expander prosthesis and size used, the type of implant coverage, and the volume of expander filling used intraoperatively.

The presence or absence of Velcro effect, double capsule and biofilm in the periprosthetic capsular tissue were noted during the second-stage expander-to-permanent implant exchange.

A total of 56 breast reconstructions were included, with 40 unilateral reconstructions and eight bilateral reconstructions. Patients were categorized into one of four groups; groups one and two received the Biocell expander (Allergan), with the first postoperative expansion at 2 weeks or less (conventional approach) or at 6 weeks or more (delayed approach), respectively. Groups three and four received the Siltex expander (Mentor), with the first postoperative expansion at 2 weeks or less (conventional approach) or at 6 weeks or more (delayed approach), respectively. Thirteen to 15 breast reconstructions were included in each of the four study groups.

No clinically observable cases of Velcro effect were noted in group one; however, a biofilm was clinically identifiable in 53.8% of breast capsules, according to the researchers. Additionally, double capsule was noted in seven cases intraoperatively and associated with the same cases in which a biofilm was observed.

All cases exhibited a clinical Velcro effect and a high level of 3-D texture in group two. Additionally, the researchers observed a high cellularity within this group of patients.

No cases of Velcro effect were found in group three, and a low cellularity was noted in this group. Also, group three included three cases of biofilm but no cases of clinical double capsule intraoperatively, according to the researchers.

Group four was also observed to have no cases of Velcro effect. Cellularity was also low and was comparable to that found in group three, the researchers reported. Biofilm was found in two breast capsules, and no cases of clinical double capsule were found intraoperatively, according to the researchers.

First-stage complication rates were similar between the four groups and ranged from 7.7% to 13.3%.

The researchers concluded that, as a result of the more pronounced 3-D texture of capsules observed in the delayed Biocell group, there may be benefits to delaying the first postoperative saline inflation until 6 weeks after implant insertion. - by Abigail Sutton

Disclosures: Paek reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.