Judging an Expander by Its Cover: A Propensity-Matched Analysis of the Impact of Tissue Expander Surface Texture on First-Stage Breast Reconstruction Outcomes

Abstract

Background: There is increased scrutiny of texturing on implants and a paucity of data looking at texturing on expanders. Because of the difficulty in controlling potential confounders with these comparative studies, the authors performed propensity matching between smooth and textured tissue expander cohorts to provide definitive insight into the impact of expander texture on breast reconstruction outcomes. Methods: A single-surgeon experience with immediate two-stage breast reconstruction was reviewed for 90-day postoperative complications after mastectomy and expander placement. Variables extracted included demographics, comorbidities, tissue expander texturing, mastectomy type, infection, seroma, skin flap necrosis, dehiscence, explantation, and overall complication rates. Subjects were 1:1 propensity matched using the nearest neighbor matching algorithm with caliper (maximum propensity score difference) of 0.2, and chi-square test was performed for statistical analysis. Results: After 1:1 propensity matching, 282 reconstructed breasts were analyzed (141 textured versus 141 smooth expanders). Textured expanders had higher minor infection rates than smooth expanders (5.0 percent versus 0 percent; p = 0.024). Smooth expanders had higher seroma rates than textured expanders (5.0 percent versus 0.7 percent; p = 0.031). Smooth expanders also had longer drain retention (20.4 days versus 16.8 days; p = 0.001). There was no difference in other complications, including major infection, explantation, or any complication, between textured and smooth expanders. Conclusions: Textured expanders are associated with increased minor infection risk, whereas smooth expanders are associated with increased seroma formation. However, these differing complication profiles coalesce to equal explantation rates. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Outcomes Analysis of Textured Versus Smooth Tissue Expanders in Breast Reconstruction

“…15 In contrast with the findings from Wen-Kuan Chiu et al, our study did not find any difference in seroma rates (2% smooth TE, 3.4 textured TE; P = 1) or in infection risk requiring both oral (9.5% smooth TE, 11.3% textured TE; P = 0.6165) and IV (21.8% smooth TE, 20.2% textured TE; P = 0.7986) antibiotics. 15 The complications rates of textured and smooth devices, both short and long term, are better understood in implant devices, with less of an understanding of expander devices due to the paucity of research in this area. Our study is unique in that we retrospectively reviewed 394 patients (147 patients with STEs and 247 with TTEs) who underwent tissue expander placement by multiple surgeons after mastectomy over a 5-year period.…”

Smooth Versus Textured Tissue Expander Breast Reconstruction: Complications and Efficacy

“…Recently, two studies described complication profiles of TEs specifically, although they did not compare the rate of malpositioning or evaluate time to final reconstruction. 19,20 Both studies reported overall smooth TE complication rates to be lower at 15.6% than textured TE (26.1% and 19.1%) and comparable to rates reported in this study.…”

“…Because prevention of malpositioning is a major advantage cited with textured devices, it is important to determine if this is a significant impediment to smooth TE use. Fairchild et al 19 described a smooth expander malposition rate of 2.9% compared with 13.6% reported in this study. Although our rate is notably higher than that reported in the previous study, this could be explained in part in that they included only patients who required surgical correction of the malpositioned pocket.…”

“…Particularly considering the association of textured devices with BIA-ALCL, 18 it is prudent that studies investigate the safety and efficacy of surface texture on complication profiles and reconstructive outcomes. Recently, two studies described complication profiles of TEs specifically, although they did not compare the rate of malpositioning or evaluate time to final reconstruction 19,20 . Both studies reported overall smooth TE complication rates to be lower at 15.6% than textured TE (26.1% and 19.1%) and comparable to rates reported in this study.…”

“…The most feared complication in the use of TEs in breast reconstruction is explanation, resulting in delay of reconstruction as well as emotional, physical, and financial burden to the patient. Previously reported explantation rate for smooth TEs is 3.5%, 19,20 and that for textured TEs is 8.6% 20 . Reasons reported for explantation include mastectomy flap necrosis, dehiscence, infection, and patient preference.…”