Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Smooth versus Textured Tissue Expanders: Comparison of Outcomes and Complications in 536 Implants

  • Omar Allam (Division of Plastic Surgery, Department of Surgery, Yale School of Medicine) ;
  • Jacob Dinis (Division of Plastic Surgery, Department of Surgery, Yale School of Medicine) ;
  • Mariana N. Almeida (Division of Plastic Surgery, Department of Surgery, Yale School of Medicine) ;
  • Alexandra Junn (Division of Plastic Surgery, Department of Surgery, Yale School of Medicine) ;
  • Mohammad Ali Mozaffari (Division of Plastic Surgery, Department of Surgery, Yale School of Medicine) ;
  • Rema Shah (Division of Plastic Surgery, Department of Surgery, Yale School of Medicine) ;
  • Lauren Chong (Division of Plastic Surgery, Department of Surgery, Yale School of Medicine) ;
  • Olamide Olawoyin (Division of Plastic Surgery, Department of Surgery, Yale School of Medicine) ;
  • Sumarth Mehta (Division of Plastic Surgery, Department of Surgery, Yale School of Medicine) ;
  • Kitae Eric Park (Division of Plastic Surgery, Department of Surgery, Yale School of Medicine) ;
  • Tomer Avraham (Division of Plastic Surgery, Department of Surgery, Yale School of Medicine) ;
  • Michael Alperovich (Division of Plastic Surgery, Department of Surgery, Yale School of Medicine)
  • Received : 2023.02.03
  • Accepted : 2023.07.27
  • Published : 2024.01.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background Increasing concerns regarding the safety of textured surface implants have resulted in surgeons transitioning from textured tissue expanders (TEs) to smooth TEs. Given this change has only recently occurred, this study evaluated outcomes between smooth and textured TEs. Methods Women who underwent two-stage breast reconstruction using TEs from 2013 to 2022 were included. TE-specific variables, perioperative information, pain scores, and complications were collected. Chi-squared, t-test, and linear regression analyses were performed. Results A total of 320 patients received a total of 384 textured and 152 smooth TEs. Note that 216 patients received bilateral reconstruction. TEs were removed in 9 cases. No significant differences existed between groups regarding comorbidities. Smooth TEs had a higher proportion of prepectoral placement (p < 0.001). Smooth TEs had less fills (3±1 vs. 4±2, p < 0.001), shorter expansion periods (60±44 vs. 90±77 days, p < 0.001), smaller expander fill volumes (390±168 vs. 478±177 mL, p < 0.001), and shorter time to exchange (80±43 vs. 104±39 days, p < 0.001). Complication rates between textured and smooth TEs were comparable. Smooth TE had a greater proportion of TE replacements (p = 0.030). On regression analysis, pain scores were more closely associated with age (p = 0.018) and TE texture (p = 0.046). Additional procedures at time of TE exchange (p < 0.001) and textured TE (p = 0.017) led to longer operative times. Conclusion As many surgeons have transitioned away from textured implants, our study shows that smooth TEs have similar outcomes to the textured alternatives.

Keywords

Acknowledgement

This study was completed in part with financial support from a research grant from the Mentor Corporation (grant no: 20-002996).

References

  1. Alderman AK, Collins ED, Schott A, et al. The impact of breast reconstruction on the delivery of chemotherapy. Cancer 2010;116(07):1791-1800  https://doi.org/10.1002/cncr.24891
  2. Olfatbakhsh A, Haghighat S, Tabari M, et al. Patient satisfaction and body image following mastectomy, breast-conserving therapy, and mastectomy with reconstruction: a study in Iran. Arch Breast Cancer 2018;5:173-182  https://doi.org/10.32768/abc.201854173-182
  3. Momoh AO, Cohen WA, Kidwell KM, et al. Tradeoffs associated with contralateral prophylactic mastectomy in women choosing breast reconstruction: results of a prospective multicenter cohort. Ann Surg 2017;266(01):158-164  https://doi.org/10.1097/SLA.0000000000001840
  4. Jagsi R, Jiang J, Momoh AO, et al. Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States. J Clin Oncol 2014;32(09):919-926  https://doi.org/10.1200/JCO.2013.52.2284
  5. Wilkins EG, Alderman AK. Breast reconstruction practices in North America: current trends and future priorities. Paper presented at: Seminars in Plastic Surgery;. 2004 
  6. Panchal H, Matros E. Current trends in post-mastectomy breast reconstruction. Plast Reconstr Surg 2017;140( 5S Advances in Breast Reconstruction):7S-13S  https://doi.org/10.1097/PRS.0000000000003941
  7. Statistics ANCoPSP. 2019 Plastic Surgery Statistics Report. In: ASPS Arlington Heights. , Illinois; 2019 
  8. Barnsley GP, Sigurdson LJ, Barnsley SE. Textured surface breast implants in the prevention of capsular contracture among breast augmentation patients: a meta-analysis of randomized controlled trials. Plast Reconstr Surg 2006;117(07):2182-2190  https://doi.org/10.1097/01.prs.0000218184.47372.d5
  9. Swanson E. Plastic surgeons defend textured breast implants at 2019 US Food and Drug Administration hearing: why it is time to reconsider. Plast Reconstr Surg Glob Open 2019;7(08):e2410 
  10. Collett DJ, Rakhorst H, Lennox P, Magnusson M, Cooter R, Deva AK. Current risk estimate of breast implant-associated anaplastic large cell lymphoma in textured breast implants. Plast Reconstr Surg 2019;143(3S A Review of Breast Implant-Associated Anaplastic Large Cell Lymphoma, 3S):30S-40S  https://doi.org/10.1097/PRS.0000000000005567
  11. Danilla SV, Jara RP, Miranda F, et al. Is Banning texturized implants to prevent breast implant-associated anaplastic large cell lymphoma a rational decision? A meta-analysis and cost-effectiveness study. Aesthet Surg J 2020;40(07):721-731  https://doi.org/10.1093/asj/sjz343
  12. Chun YS, Verma K, Rosen H, et al. Implant-based breast reconstruction using acellular dermal matrix and the risk of postoperative complications. Plast Reconstr Surg 2010;125(02):429-436  https://doi.org/10.1097/PRS.0b013e3181c82d90
  13. Kouwenberg CAE, de Ligt KM, Kranenburg LW, et al. Long-term health-related quality of life after four common surgical treatment options for breast cancer and the effect of complications: a retrospective patient-reported survey among 1871 patients. Plast Reconstr Surg 2020;146(01):1-13  https://doi.org/10.1097/PRS.0000000000006887
  14. Lim YM, Park KH, Lee DW, Lew DH, Roh TS, Song SY. Characteristics of adhesion areas between the tissue expander and capsule in implant-based breast reconstruction. Arch Plast Surg 2019;46(04):330-335  https://doi.org/10.5999/aps.2018.00395
  15. Fairchild B, Ellsworth W, Selber JC, et al. Safety and efficacy of smooth surface tissue expander breast reconstruction. Aesthet Surg J 2020;40(01):53-62  https://doi.org/10.1093/asj/sjy199
  16. Chiu WK, Fracol M, Feld LN, Qiu CS, Kim JYS. Judging an expander by its cover: a propensity-matched analysis of the impact of tissue expander surface texture on first-stage breast reconstruction outcomes. Plast Reconstr Surg 2021;147(01):1e-6e  https://doi.org/10.1097/PRS.0000000000007417
  17. Danino MA, Efanov JI, Dimitropoulos G, et al. Capsular biofilm formation at the interface of textured expanders and human acellular dermal matrix: a comparative scanning electron microscopy study. Plast Reconstr Surg 2018;141(04):919-928  https://doi.org/10.1097/PRS.0000000000004216
  18. Le NK, Persing S, Dinis J, et al. A comparison of BREAST-Q scores between prepectoral and subpectoral direct-to-implant breast reconstruction. Plast Reconstr Surg 2021;148(05):708e-714e  https://doi.org/10.1097/PRS.0000000000008410
  19. Manrique OJ, Kapoor T, Banuelos J, et al. Single-stage direct-to-implant breast reconstruction: a comparison between subpectoral versus prepectoral implant placement. Ann Plast Surg 2020;84(04):361-365  https://doi.org/10.1097/SAP.0000000000002028
  20. Helme RD, Gibson SJ. The epidemiology of pain in elderly people. Clin Geriatr Med 2001;17(03):417-431, v  https://doi.org/10.1016/S0749-0690(05)70078-1
  21. Krueger AB, Stone AA. Assessment of pain: a community-based diary survey in the USA. Lancet 2008;371(9623):1519-1525  https://doi.org/10.1016/S0140-6736(08)60656-X
  22. Rustoen T, Wahl AK, Hanestad BR, Lerdal A, Paul S, Miaskowski C. Age and the experience of chronic pain: differences in health and quality of life among younger, middle-aged, and older adults. Clin J Pain 2005;21(06):513-523  https://doi.org/10.1097/01.ajp.0000146217.31780.ef
  23. Walia GS, Aston J, Bello R, et al. Prepectoral versus subpectoral tissue expander placement: a clinical and quality of life outcomes study. Plast Reconstr Surg Glob Open 2018;6(04):e1731 
  24. Yang JY, Kim CW, Lee JW, Kim SK, Lee SA, Hwang E. Considerations for patient selection: prepectoral versus subpectoral implant-based breast reconstruction. Arch Plast Surg 2019;46(06):550-557  https://doi.org/10.5999/aps.2019.00353