Introduction: Because of concerns related to the correlation of breast implantassociated anaplastic large cell lymphoma (BIA-ALCL) and textured implants, the use of smooth devices in breast reconstruction has been increasing. Currently, there is a paucity of literature evaluating the safety of smooth tissue expanders (STEs), which are now being used more frequently in first-stage breast reconstruction. This study sought to compare the safety and outcomes associated with STEs compared with textured tissue expanders in prosthesis-based breast reconstruction. Methods: A single-institution retrospective review of 394 patients undergoing tissue expander-based breast reconstruction (147 smooth and 247 textured) between 2015 and 2019 was conducted. Patient demographics, comorbidities, treatment characteristics, complications, and surgical outcomes were evaluated. Data analysis was performed using Fisher exact and t tests. Results: No significant difference in demographics or complication rates were identified, including rates of hematoma, seroma, wound dehiscence, delayed wound healing, infection, tissue expander malposition, nipple necrosis, mastectomy flap necrosis, reoperation, readmission, and explantation. Average follow-up was 19 and 22 months for the smooth and textured groups, respectively. No cases of BIA-ALCL were identified in either group. Conclusions: With equivocal safety profiles and no demonstrated risk in BIA-ALCL associated with STEs, this study supports the safety of using STEs compared with textured tissue expanders in prosthesis-based breast reconstruction with the advantage in preventing BIA-ALCL and concludes that there is no role for textured breast expanders.

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Objective: The U.S. Virgin Islands (USVI) currently has the 3 rd highest per capita rate of HIV in the United States. The purpose of this descriptive study was to examine the risk factors that contribute to high rates of HIV in the USVI.Methods: Data from the CDC Behavioral Risk Factor Surveillance System (BRFSS) from 2005 and 2009 were examined using statistical analysis with PASW 18.0 software. Local HIV surveillance data presented in the USVI 2012-2016 HIV Prevention Plan was also reviewed. Descriptive statistics were conducted using chi squared tests and a logistical regression model to examine sociodemographic factors that may contribute to HIV risk.Results: Aggregation of data from the USVI indicate an increase in reported history of HIV testing and a decrease in reported high HIV-associated risk behavior between 2005 and 2009. Analysis of the data showed that being a young adult significantly (twice higher) increased the odds of being at high risk for HIV as 19.7% of 18-24 year olds reported high HIV risk. Adults between the ages of 25-44 were 2.2 times more likely to be at a high risk for HIV, and 59.2% reported high risk. Being between the ages of 25 and 44 was the only found statistically significant predictor of high HIV risk of any category, even among other categories that were reported as being at high risk by the 2014 USVI HIV Surveillance Report. Conclusion:Using results from this study, future HIV prevention plans could be tailored to the high risk age group of young adults in order to facilitate HIV care and treatment. More studies are needed to examine the HIV-associated sexual risk behaviors of young adults in the USVI and to facilitate the development of appropriate HIV prevention interventions for this population.

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