Are tissue expanders always filled with saline or can they also be filled with air?

Question

Hi doctors, breast tissue expanders, are they always filled with Saline, I read that it is also possible to fill them with air?

Ryan Rebowe, MD · Answer

Filling of expanders with saline or air is debated in the plastic surgery literature. What your surgeon chooses will be dependent on their experience and also possibilities for postoperative radiation. There is evidence that postoperative radiation is not possible following filling of the expanders with air. From a patient perspective, it is important to know that while some studies can show decreased time to fill, decreased pain, etc, with air filling of expanders, the vast majority of surgeons continue to fill with Saline as it is more widely accepted.

Michael A. Fallucco, MD, FACS · Answer

Great question! Breast tissue expanders are most commonly filled with saline because saline is safe, easily adjustable, and well-tolerated by the body. Saline expanders allow gradual filling through a valve, which helps stretch the skin and muscle gently over time in preparation for the permanent implant.

That said, there are air-filled tissue expanders available, but they are much less commonly used. Air expanders can be lighter and may provide some advantages in specific clinical scenarios, but they are not as widely adopted because air can be more difficult to control and may have risks related to air embolism or leakage.

Overall, saline remains the standard choice for tissue expansion due to its safety profile, ease of monitoring, and surgeon familiarity.

Danielle Dumestre, MD · Answer

Hello!
The most common protocol is starting with air to not put so much pressure on your mastectomy flaps to allow them to get proper blood flow. Then typically the air is switched for saline to provide a more accurate amount and stretching of the pocket for your next stage of reconstruction.

Ram Kalus, MD, FACS · Answer

Thank you for your question. Tissue expanders can indeed be filled with air instead of saline short term, but the air tends to leak out. Therefore saline is generally recommended for longer term expansions of weeks to months. Please discuss with your plastic surgeon. Best of luck to you.

Connie Hiers, MD, FACS · Answer

Yes, they can be filled with air, but saline is more reliable over several weeks or months needed for the expansion. Plus, saline is sterile.

Are tissue expanders always filled with saline or can they also be filled with air?

Answers (5)

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