Textured Versus Smooth Tissue Expanders - A Comparison Of Complications In 3526 Breast Reconstructions
Jonas A. Nelson, MD, MPH1, Robyn N. Rubenstein, MD1, Joshua Vorstenbosch, MD, PhD2, Kathryn Haglich, BS, MS1, Jacqueline J. Chu, BA1, Cayla McKernan, MS, PA-C1, Tajah Bell, BS1, Richard T. Poulton, BS1, De'von McGriff, BS1, Carrie S. Stern, MD1, Michelle Coriddi, MD1, Peter G. Cordeiro, MD1, Colleen M. McCarthy, MD, MS1, Joseph J. Disa, MD1, Babak Mehrara, MD1, Evan Matros, MD, MMSc., MPH1.
1Memorial Sloan Kettering Cancer Center, New York, NY, USA, 2McGill University, Royal Victoria Hospital, Montreal, QC, Canada.
PURPOSE: With increased understanding of BIA-ALCL, a shift away from textured breast devices has occurred. Few small studies have compared complication rates of textured and smooth tissue expanders (TE). The aim of this study was to compare complication profiles in patients undergoing two stage post-mastectomy breast reconstruction with either textured or smooth tissue expanders.
METHODS: We performed a retrospective review of female patients who underwent immediate breast reconstruction with textured or smooth TEs from 2018-2020 at our institution. Demographics, comorbidities, and neoadjuvant/adjuvant therapies were evaluated. Outcomes of interest included seroma, infection/cellulitis, malposition/rotation, exposure, and expander loss. Subgroup analysis was performed to analyze prepectoral/subpectoral cohorts. We used multivariate logistic regression to evaluate the odds of certain complications occurring in textured versus smooth expanders.
RESULTS: We analyzed 3,526 TEs (1,456 textured; 2,070 smooth). Increased utilization of ADM, SPY angiography, and prepectoral expander placement were noted in the smooth TE cohort (p<0.001). Overall, a greater proportion of smooth TEs experienced infection/cellulitis (6.4% vs. 4.3%), malposition/rotation, and exposure than textured TEs (all p<0.01). No significant differences were noted comparing expander loss. In multivariate analysis, textured expanders had lower odds of experiencing infection/cellulitis and malposition/rotation; however, there was no significant relationship between odds of TE loss and expander surface.
CONCLUSION: In the largest study to date examining textured versus smooth TE outcomes, expander surface did not impact TE loss, though differences favored textured expanders overall. Further research is needed examining BIA-ALCL risk with temporary textured TE exposure to improve decision-making regarding use of textured expanders.
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