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

BACKGROUND:There is increased scrutiny of texturing on implants and a paucity of data looking at texturing on expanders. Due to the difficulty in controlling potential confounders with these comparative studies, we 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 (JK) experience with immediate two stage breast reconstruction was reviewed for 90 day post-operative 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% versus 0%, p=0.024). Smooth expanders had higher seroma rates than textured expanders (5.0% versus 0.7%, p=0.031). Smooth expanders also had longer drain retention (20.4 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. CONCLUSION:Textured expanders are associated with increased minor infection risk while smooth expanders are associated with increased seroma formation. However, these differing complication profiles coalesce to equal explantation rates.