LAUSR

BACKGROUND Increased understanding of breast implant-associated anaplastic large cell lymphoma(BIA-ALCL) has led to a shift away from textured breast devices. 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 post-mastectomy breast reconstruction with either textured or smooth TEs. METHODS We performed a retrospective review of female patients who underwent immediate breast reconstruction with textured or smooth TEs from 2018 to 2020 at our 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 We analyzed 3,526 TEs(1,456 textured; 2,070 smooth). More frequent use of acellular dermal matrix(ADM), 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, though increased rates of expander malposition were noted in the smooth prepectoral cohort. Further research is needed to examine BIA-ALCL risk with temporary textured TE exposure to improve decision-making.