Early Post-Operative Complications in 1,225 Prepectoral Tissue Expanders: A single institution study
Robyn N. Rubenstein, MD; Evan Matros, MD, MPH, MMSc.; Ethan L. Plotsker, BA; Kathryn Haglich, MS; Carrie S. Stern, MD; Michelle Coriddi MD; Joseph J. Disa MD, Babak J. Mehrara, MD; Jonas A. Nelson, MD, MPH
Memorial Sloan Kettering Cancer Center, New York, NY
Background: The use of prepectoral two-stage post-mastectomy breast reconstruction has recently increased. Benefits of prepectoral reconstruction include lack of animation deformities and reduced post-operative pain. The aim of this study was to examine the early post-operative complication profile of prepectoral tissue expanders (TEs) at our institution to guide surgical decision making in patients who may be candidates for prepectoral reconstruction.
Methods: We performed a retrospective review of patients who underwent immediate reconstruction with a prepectoral TE from January 2018 to June 2021 at Memorial Sloan Kettering Cancer Center. Patient demographics, comorbidities, and operative details were evaluated. Outcomes of interest included seroma, hematoma, infection/cellulitis, mastectomy skin flap necrosis (MSFN) requiring revision, TE exposure, capsular contracture, and TE loss. We compared characteristics of the “loss” versus “no loss” cohort. Multivariate logistic regression assessed factors associated with increased odds of TE loss.
Results: A total of 741 patients and 1,225 TEs were included. Mean age was 46.6 years. The majority of patients were non-Hispanic (81.1%), white (69.8%), never smokers (76.8%), and the mean BMI was 26.8. Overall, 79.4% of mastectomies were skin-sparing, 9.8% of mastectomies were associated with an axillary lymph node dissection, 72.4% of TEs were smooth, 86.5% used acellular dermal matrix (ADM), 50.8% used SPY angiography, and mean mastectomy weight was 569.6 g (SD 352.9 g). The most frequent complications were seroma (8.7%, n=106), infection/cellulitis (8.2%, n=101), and TE loss (4.2%, n=51). Hematoma, TE exposure, and MSFN had complication rates of 2%, and fewer than 1% of TEs experienced early capsular contracture. In comparison to the no loss cohort, the TE loss cohort had a higher proportion of African Americans, Hispanics, smokers, higher BMI, larger TE size, greater TE fill volume, larger mastectomy weight, and neoadjuvant chemotherapy. In multivariate logistic regression analysis, increasing mastectomy weight was associated with increased odds of TE loss (OR=1.001, p = 0.016); therefore, for every 100 g increase in mastectomy weight, the odds of experiencing TE loss increased by 10%.
Conclusion: Prepectoral breast reconstruction has become an accepted option in alloplastic breast reconstruction. Our data suggest that increasing mastectomy weight is the most significant factor associated with TE loss. Further research examining the quality of the soft tissue envelope and pocket size, as well as assessment of patient reported outcomes, would prove beneficial.
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