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Objectives: 1. Review current literature regarding tissue expander fill 2. Discuss results of meta-analysis of differences in surgical outcomes based on fill of tissue expander 3. Cost-analysis on tissue expander type Introduction: Breast cancer, the second leading malignancy among U.S. women, continues to pose significant challenges despite advancements in early detection. Mastectomy remains an important treatment with implant-based reconstruction (IBR) being important in restoring postoperative quality of life. Two tissue expanders (TEs) exist: AeroForm TEs (ATEs) and saline-based TEs (STEs). With a 75% increase in breast reconstruction procedures over the past two decades, understanding the strengths and challenges of these TE options is crucial for informed decision-making, benefiting both patients and physicians. Materials / method: We performed a PubMed literature review to search for studies comparing air and saline-based tissue expanders used in implant-based reconstruction from January 1st, 1993 to May 27th, 2023. We then performed a meta-analysis on the following post-operative outcomes: implant rupture, wound dehiscence, skin necrosis, nipple necrosis, expander exposure, expander loss, hematoma, seroma, infection/cellulitis/abscess formation, and salvage reoperation. A random effects model was used to calculate odds ratios (OR) within and a 95% confidence interval (CI) for dichotomous outcomes. Results: We included eleven studies from forty-four reviewed. Analysis of ten studies revealed that infection risk after TE placement was significantly lower in the ATE cohort, with 11.3% of ATE patients (109/966) experiencing infection compared to 20.8% of STE patients (242/1163) (P = 0.0009). In terms of the time required for expansion before definitive reconstruction, data from six studies indicated that ATEs were associated with a significantly shorter time to reconstruction (114.7 days for ATE vs. 176.8 days for STE, P < 0.00001). Use of ATEs saved $2,055.34 compared to STEs. Conclusion: ATEs exhibited a notable advantage in reducing the risk of infection compared to STEs. ATEs had a reduced overall cost of $2,055.34. Use of ATEs demonstrated a shorter duration for achieving full expansion and reaching the stage of definitive reconstruction following placement. ATEs also do not require multiple office visits for expansion. The reduction in postoperative clinic visits can have significant implications for patients, as it may lead to a more efficient and streamlined overall treatment process. These findings highlight the potential advantage of using ATEs over STEs.