With all of the talk about textured implants and their risk of ALCL and biofilm, and with removal of the textured implants from Allergan from the market, the question remains: what do you do for tissue expander breast cancer reconstruction? Tissue expanders have historically been textured, to prevent rotation and help maintain the orientation of the port for fluid injection. What happens if the tissue expander is smooth? Are there issues?
The Aesthetic Surgery Journal January 2020 had a study, “Safety and Efficacy of Smooth Surface Tissue Expander Breast Reconstruction.”
Study:
- 112 patients from 3 institutions, done from 2016-2017.
- Retrospective study done.
- Mean follow up 14 months
- Average age 53, Average BMI 27
- 18.6% got postop radiation.
Findings?
- Overall complication rates were 15.6%.
- Ski necrosis 10.4%
- seroma 5.2%
- Expander malposition 2.9%
- Infection requiring IV antibiotics 3.5%
- Six unplanned reoperations with explant.
- Conclusion? “Smooth surface tissue expanders are a safe and efficacious alternative to textured tissue expander breast recon.”
They do think the technique needs to be modified, using things like tab fixation (where you sew a tab down to the tissue to keep the implant from moving), strict pocket control (where the space you make for the implant is the exact size of the implant to help prevent migration or rotation), postoperative bra support (to try to keep anything from moving- try to cement it into its space), and suture choice may contribute to observed favorable outcomes.
Of note, they used ADM to help fix the tissue expander pocket. Drains were used. They think 3.0PDS or 3.0 Prolene were good to suture the tabs with. Bras were worn after surgery 24/7 for one month, and activity was limited for one month.
Thoughts?
It’s good insights in how to use smooth expanders. The fact the complication rates were comprable to the textured expanders is good. If we can minimize biofilm or the risk of ALCL, it seems to be a good choice.