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Soft Tissue Support in Prepectoral Tissue Expander Reconstruction: Do We Need It?
Carter J. Boyd*, Kshipra Hemal, Sofia Perez Otero, Raessa Kabir, Vishal Thanik, Jamie P. Levine, Oriana Cohen, Mihye Choi, Nolan S. Karp
Hansjörg Wyss Department of Plastic Surgery, NYU Langone, New York, NY

Soft tissue support (STS), such as acellularized dermal matrix (ADM), has contributed to the rise of prepectoral breast reconstruction. Its use, however, introduces added cost to the initial reconstruction and continual investigation of its utility and outcomes is warranted. This study assesses the impact of STS in prepectoral breast reconstruction.
A chart review of all consecutive, prepectoral tissue expander reconstructions performed between March 2017 and July 2022 at a single center was conducted. Patients from 5 distinct breast surgeons and 5 plastic surgeons were included. Demographics, operative characteristics, and complications were extracted. Multivariate logistic regression was used to predict complications while controlling for STS. A p<0.05 was considered statistically significant.
A total of 184 patients (292 breasts) were included. STS was used in 61 (21%) breasts. On average, women were 53 years old, non-smoker (99%), non-diabetic (91%), and had a body mass index of 28. All breasts underwent immediate reconstruction (prophylactic 33%; therapeutic 67%). Seventy-one (24%) breasts were radiated, and 89 (48%) patients received chemotherapy. Mean follow up was 27 months. Median mastectomy weight was 551 grams, average intraoperative TE fill was 194 163 ccs, and average final TE fill was 416 159 ccs. Major complications occurred in 61 (21%) breasts while minor complications occurred in 85 (29%) of breasts. On univariate analysis, STS was associated with fewer minor complications (15% vs. 33%, p<0.01). In multivariable models, STS was associated with fewer minor complications (OR 0.36 [0.16-0.76], p=0.01) and a weak association with fewer seromas (0.40 [0.14-1.11], p = 0.08) and a lower rate of explantation (0.40 [0.13-1.02], p = 0.08).
In this study, STS use in prepectoral tissue expander reconstruction reduced postoperative complications in the immediate postoperative period. Further investigation is warranted to analyze costs and long-term reconstructive and aesthetic outcomes between these two cohorts.


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