Textured versus Smooth Tissue Expanders: a Comparison of Complications in 3,526 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.

Is There a Role for Textured Tissue Expanders in Breast Reconstruction?

“…Smooth expanders were slightly larger (436 vs 406 mL, P < 0.001) and had higher initial fill volumes (215 vs 182 mL, P < 0.001). Prepectoral placement (32.8% vs 18.9%, P < 0.001) and acellular dermal matrix (46.2% vs 28.4%, P < 0.001) were used more frequently in the more recent group who received smooth expanders 5 …”

“…The authors selected 5 studies for inclusion in their meta-analysis. Four studies contained explantation data 2–5 . One of these studies, by Nelson et al, 5 reported a large experience at Memorial Sloan Kettering Cancer Center.…”

“…Four studies contained explantation data 2–5 . One of these studies, by Nelson et al, 5 reported a large experience at Memorial Sloan Kettering Cancer Center. This single study accounted for 67.7% of the expanders in the explantation meta-analysis 1 .…”

“…This single study accounted for 67.7% of the expanders in the explantation meta-analysis 1 . Surprisingly, Fijany et al 1 included the raw data, as opposed to the propensity-matched data, from this study 5 …”

“…The authors of this large contributing study emphasized the importance of confounders in their comparison 5 . Tissue expanders inserted before the July 24, 2019, recall of Allergan Biocell textured devices (AbbVie, North Chicago, IL) were primarily textured (75.4% textured vs 24.6% smooth).…”