Textured versus Smooth Tissue Expanders - A Comparison of Complications in 3539 Breast Reconstructions
Robyn N. Rubenstein, MD, Kathryn Haglich, BS, MS, Jacqueline J. Chu, BA, Cayla McKernan MS, PA-C, Tajah Bell, Richard T. Poulton, De'von McGriff, Carrie S. Stern, MD, Michelle Coriddi, MD, Peter G. Cordeiro, MD; MD, Colleen M. McCarthy, MD, MS, Joseph J. Disa MD, Babak J. Mehrara, MD, Evan Matros, MD, MPH, MMSc., Jonas A. Nelson, MD, MPH
Memorial Sloan Kettering Cancer Center, New York, NY, USA
Background: With the increased awareness and understanding of Breast Implant-Associated Anaplastic Large Cell Lymphoma, a shift has occurred away from use of textured breast implants in the United States. Tissue expander (TE) surface type has also come under scrutiny, with smooth tissue expanders being increasingly used in two stage implant-based reconstruction. To date, studies comparing complication rates of textured and smooth tissue expanders have been underpowered. The purpose of this study is to compare complication rates in patients undergoing two stage post-mastectomy breast reconstruction with either textured or smooth tissue expanders with appropriate statistical power.
Methods: We performed a retrospective review of female patients who underwent immediate breast reconstruction with textured or smooth TEs from January 2018 to December 2020 at an NCI-designated institution. Patient demographics and comorbidities, indications for mastectomy, and neo-adjuvant and adjuvant treatment with chemotherapy and/or radiation were evaluated. Outcomes of interest were rates of hematoma, seroma, infection/cellulitis, TE malposition/rotation, and TE removal. Subgroup analysis was performed to analyze subpectoral and prepectoral cohorts.
Results: During the study period, 2189 patients with 3539 TEs (1458 textured, 2081 smooth) were included in the analysis. Few differences were noted regarding demographic and surgical characteristics of the cohorts, though increased utilization of acellular dermal matrix and prepectoral expander placement was noted in the smooth TE cohort (p<0.05, p<0.01). No significant differences were noted comparing textured and smooth expander loss overall (4.1% vs. 4.7%, p=0.41). A greater proportion of smooth TEs experienced infection or cellulitis (6.9% vs. 4.7%, p<0.01). In subgroup analysis by plane of reconstruction, 73% of TEs were subpectoral and 27% prepectoral. Subpectoral smooth TEs were noted to have a higher rate of infection/cellulitis compared to subpectoral textured TEs (6.1% vs. 3.6%, p<0.01). Prepectoral smooth TEs experienced higher rates of rotation or malposition (2.5% vs. 0.4%, p=0.03).
Conclusions: In one of the highest-powered studies to date examining textured and smooth tissue expander outcomes, tissue expander surface type did not impact expander loss outcomes, though differences did exist favoring textured expanders regarding infection and undesired TE rotation or malposition. Further research is needed to understand the impact of short textured expander exposure time and subsequent risk for development of BIA-ALCL to improve decision making regarding use of textured expanders for two stage breast reconstruction.
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