Textured versus Smooth Tissue Expanders: A Comparison of Complications in 3526 Breast Reconstructions.

Abstract

BACKGROUND:

Increased understanding of breast implant-associated anaplastic large-cell lymphoma has led to a shift away from textured breast devices. A few small studies have compared the complication rates of textured and smooth tissue expanders (TEs). The aim of this study was to compare complication profiles in patients undergoing two-stage postmastectomy breast reconstruction with either textured or smooth TEs.

METHODS:

The authors performed a retrospective review of female patients who underwent immediate breast reconstruction with textured or smooth TEs from 2018 to 2020 at their institution. Rates of seroma, infection/cellulitis, malposition/rotation, exposure, and TE loss were analyzed in the overall cohort and subgroups undergoing prepectoral and subpectoral TE placement. A propensity score-matched analysis was used to decrease the effects of confounders comparing textured and smooth TEs.

RESULTS:

The authors analyzed 3526 TEs (1456 textured and 2070 smooth). More frequent use of acellular dermal matrix, SPY angiography, and prepectoral TE placement was noted in the smooth TE cohort ( P < 0.001). Univariate analysis suggested higher rates of infection/cellulitis, malposition/rotation, and exposure in smooth TEs (all P < 0.01). Rates of TE loss did not differ. After propensity matching, no differences were noted in infection or TE loss. Prepectoral smooth expanders had increased rates of malposition/rotation.

CONCLUSIONS:

TE surface type did not affect rates of TE loss, although increased rates of expander malposition were noted in the smooth prepectoral cohort. Further research is needed to examine breast implant-associated anaplastic large-cell lymphoma risk with temporary textured TE exposure to improve decision-making.

CLINICAL QUESTION/LEVEL OF EVIDENCW:

Therapeutic, III.

• Authors: Jonas A Nelson, Robyn N Rubenstein, Joshua Vorstenbosch, Kathryn Haglich, Richard T Poulton, De'von McGriff, Carrie S Stern, Michelle Coriddi, Peter G Cordeiro, Colleen M McCarthy, Joseph J Disa, Babak J Mehrara, Evan Matros
• Journal: Plastic and reconstructive surgery (Plast Reconstr Surg) Vol. 153 Issue 2 Pg. 262e-272e (02 01 2024) ISSN: 1529-4242 [Electronic] United States
• PMID: 37104467 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2023 by the American Society of Plastic Surgeons.

Topics

• Female
• Humans
• Tissue Expansion Devices (adverse effects)
• Cellulitis (etiology)
• Breast Neoplasms (surgery, complications)
• Lymphoma, Large-Cell, Anaplastic (epidemiology, etiology)
• Mastectomy (adverse effects)
• Postoperative Complications (epidemiology, etiology)
• Mammaplasty (adverse effects)
• Breast Implants (adverse effects)
• Retrospective Studies