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Smooth Tissue Expanders As The New Standard In Breast Reconstruction: A Propensity Matched Comparison Of Smooth Versus Textured Tissue Expanders
Kevin Perez, M.Sc.1, Y. Edward Wen, B.A.1, Pope Rodnoi, B.S.1, Sami Khan, M.D.2, Yulun Liu, Ph.D.1, Sumeet Teotia, M.D.1, Nicholas Haddock, M.D.1.
1University of Texas - Southwestern, Dallas, TX, USA, 2Stony Brook University Medical Center, Stony Brook, NY, USA.

PURPOSE: Textured tissue expanders (TE) had previously gained popularity due to minimizing expander migration, rotation, and capsule migration. Recent studies though have revealed increased risk of anaplastic large-cell lymphoma associated with certain macro-textured implants, prompting surgeons at our institution to switch to smooth TEs - evaluation thus is required for specific viability and similarity of outcomes of smooth TEs. Our study aims to evaluate perioperative complications in pre-pectoral placement of smooth versus textured TEs.
METHODS: Our retrospective study evaluated perioperative outcomes of patients who underwent bilateral pre-pectoral TE placement, with either smooth or textured TE, at an academic institution between 2017 - 2021 performed by two reconstructive surgeons. The perioperative period was defined as the interval between expander placement until conversion to flap/implant or removal of TE due to complications. Our primary outcomes included hematoma, seroma, wounds, infection, unspecified redness, total number of complications, and returns to OR secondary to complications. Secondary outcomes included time to drain removal, total number of expansions, hospital length of stay, length of time until next breast reconstruction procedure, next breast reconstruction procedure, and number of expansions.
RESULTS: 222 patients were evaluated in our study (141 textured, 81 smooth). After propensity matching, our univariate logistic regression showed no significant difference in perioperative complications between smooth and textured expanders (17.1% vs. 21.1%; p = 0.396) or complications that required a return to the OR (10.0% vs. 9.2%; p = 0.809). No significant differences were noted for hematoma, seroma, infections, unspecified redness or wounds between both groups. A significant difference was noted in days to drain out (18.578.17 vs. 20.130.07, p=0.001) and type of next breast reconstruction procedure (p<0.001). Our multivariate regression showed that breast surgeon, hypertension, smoking status, and mastectomy weight were significant for increased risk for complications (Table 1).
CONCLUSION: Our study demonstrates similar rates and effectiveness of smooth versus textured TE when used for pre-pectoral placement, making smooth TEs a valuable alternative for breast reconstruction due to their decreased risk of anaplastic large-cell lymphoma.


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