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Textured Versus Smooth Tissue Expanders - A Comparison Of Complications In 3526 Breast Reconstructions
Robyn Nicole Rubenstein, MD1, Evan Matros, MD, MMSc., MPH1, 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, MBA, MHA1, Carrie S. Stern, MD1, Michelle Coriddi, MD1, Peter G. Cordeiro, MD1, Colleen M. McCarthy, MD, MS1, Joseph J. Disa, MD1, Babak J. Mehrara, MD1, Jonas A. Nelson, MD, 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), and those that did had small sample sizes. 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. Categorical variables were evaluated in smooth versus textured cohorts using Fisherís exact test while continuous variables were compared using Studentís t-test. Outcomes of interest included seroma, infection/cellulitis, malposition/rotation, exposure, and expander loss. Subgroup analysis was performed to analyze prepectoral/subpectoral cohorts. Further analysis was performed to assess the proportion of each complication that led to the overall loss of a tissue expander without replacement. We used multivariate logistic regression, controlling for clinically-relevant variables, to evaluate the odds of certain complications occurring in textured versus smooth expanders. A p-value of <0.05 was considered statistically significant.
RESULTS: We analyzed a total of 2,188 patients and 3,526 TEs (1,456 textured; 2,070 smooth). Basic demographics and comorbidities were similar between the textured and smooth TE cohorts. 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%, p=0.007), malposition/rotation (1.6% vs. 0.5%, p=0.004), and TE exposure (1.6% vs. 0.6%, p=0.007), than textured TEs. TE removal without replacement (TE loss) did not differ significantly between the overall smooth and textured cohorts (4.4% vs. 3.9%, p=0.496). In subgroup analysis, prepectoral smooth TEs experienced higher rates of hematoma (2.9% vs. 0.4%, p=0.013) compared to prepectoral textured TEs. TE loss did not differ significantly between the prepectoral smooth and textured cohorts (5.5% vs. 7.2%, p=0.294). Subpectoral smooth TEs had a higher rate of infection/cellulitis (5.3% vs. 3.6%, p=0.046) and TE exposure (1.2% vs. 0.4%, p=0.032) compared to subpectoral textured TEs. TE loss did not differ significantly between the subpectoral smooth and textured cohorts (3.9% vs. 3.1%, p=0.336). Infection/cellulitis was the leading cause of TE loss overall (smooth: 66.3%; textured: 60.3%) and within the prepectoral (smooth: 76.9%; textured: 53.8%) and subpectoral (smooth: 59.7%; textured: 64.3%) cohorts. The second most common complication leading to TE loss was TE exposure - overall, 20.8% of smooth and 17.6% of textured TE loss was caused by TE exposure. 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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