Restoring Breast Volume in High BMI Patients: A Single-Center Review of Breast Reconstruction Using Hyperinflated Saline Implants

Milind D Kachare; Swapnil D Kachare; Bradley J Vivace; Omar Elfanagely; Brooke Barrow; Adam O'Toole; Alyssa M Simpson; Rachel Safeek; Joshua H Choo; Terry M McCurry; Bradon J Wilhelmi

Restoring Breast Volume in High BMI Patients: A Single-Center Review of Breast Reconstruction Using Hyperinflated Saline Implants

Eplasty. 2022 Jul 21:22:e30. eCollection 2022.

Affiliations

¹ Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY.
² Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
³ Department of Orthopaedic Surgery, University of Missouri, Columbia, MO.
⁴ Division of General Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
⁵ University of Louisville School of Medicine, Louisville, KY.

PMID: 36000008
PMCID: PMC9361388

Abstract

Background: Breast reconstruction in the obese patient is often fraught with poor patient satisfaction due to inadequate volume restoration. The off-label hyperinflation of saline implants is a direct yet controversial solution to this problem, with limited studies in the literature. This study sought to determine the safety and efficacy of this technique for breast reconstruction.

Methods: A retrospective chart review was performed to identify all patients with a body mass index (BMI) greater than or equal to 30 kg/m2 who underwent breast reconstruction between the years 2013 to 2020 with saline implants filled beyond the manufacturer's maximum recommended volume.

Results: The 21 patients identified had an average age of 49 years. The mean BMI was 39.5 kg/m2. A total of 42 implants were placed; 34 were 800 mL, 4 were 750 mL, and 4 were 700 mL. The average overfill volume was 302 mL (138%). Mean follow-up was 65.0 months. Of these, 1 (4.8%) patient with a history of chest wall radiotherapy underwent reoperation for unilateral implant exposure 27 days after the index procedure, no patient sustained spontaneous leak or rupture, and 1 patient had unilateral deflation following emergent central line and pacemaker placement 2 years after the implant was placed for an unrelated cardiovascular event.

Conclusions: Hyperinflation of saline implants beyond the maximum recommended volume may be considered for volume replacement in obese patients undergoing implant-based breast reconstruction. This practice is well tolerated, has a complication rate comparable to using implants filled to the recommended volume, and has the potential to restore lost breast volume in the obese patient post mastectomy.

Keywords: breast reconstruction; hyperinflation; implant based; obesity; plastic surgery; reconstructive surgery; saline implant; volume.

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