From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine.
Plast Reconstr Surg. 2021 Jan 1;147(1):1e-6e. doi: 10.1097/PRS.0000000000007417.
There is increased scrutiny of texturing on implants and a paucity of data looking at texturing on expanders. Because of the difficulty in controlling potential confounders with these comparative studies, the authors performed propensity matching between smooth and textured tissue expander cohorts to provide definitive insight into the impact of expander texture on breast reconstruction outcomes.
A single-surgeon experience with immediate two-stage breast reconstruction was reviewed for 90-day postoperative 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.
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 percent versus 0 percent; p = 0.024). Smooth expanders had higher seroma rates than textured expanders (5.0 percent versus 0.7 percent; p = 0.031). Smooth expanders also had longer drain retention (20.4 days 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.
Textured expanders are associated with increased minor infection risk, whereas smooth expanders are associated with increased seroma formation. However, these differing complication profiles coalesce to equal explantation rates.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
人们对植入物的纹理处理越来越关注，但关于扩张器纹理处理的数据却很少。由于这些比较研究中很难控制潜在的混杂因素，作者在光滑和纹理组织扩张器队列之间进行了倾向评分匹配，以提供关于扩张器纹理对乳房重建结果影响的明确见解。
回顾了一位外科医生的即时两阶段乳房重建经验，以了解乳房切除术后 90 天的并发症和扩张器放置情况。提取的变量包括人口统计学、合并症、组织扩张器纹理、乳房切除术类型、感染、血清肿、皮瓣坏死、裂开、取出和总体并发症发生率。使用卡尺（最大倾向评分差异为 0.2）的最近邻匹配算法对受试者进行 1:1 倾向匹配，并进行卡方检验进行统计分析。
在 1:1 倾向匹配后，分析了 282 例重建乳房（141 例纹理扩张器与 141 例光滑扩张器）。纹理扩张器的轻微感染率高于光滑扩张器（5.0%比 0%；p=0.024）。光滑扩张器的血清肿发生率高于纹理扩张器（5.0%比 0.7%；p=0.031）。光滑扩张器的引流管保留时间也更长（20.4 天比 16.8 天；p=0.001）。在主要感染、取出或任何并发症方面，纹理扩张器和光滑扩张器之间没有差异。
纹理扩张器与轻微感染风险增加有关，而光滑扩张器与血清肿形成增加有关。然而，这些不同的并发症特征导致取出率相等。
临床问题/证据水平：治疗，III。
