Remote Incisions as an Alternative to Mastectomy Scars for Breast Tissue Expander-to-Implant Exchange: A Propensity Score-Matched Analysis.

BACKGROUND

Two-stage prosthetic breast reconstruction involves the exchange of tissue expanders for implants, but complications of this procedure can necessitate revision operations and implant removal. The choice between remote incision (RI) and traditional access through the existing mastectomy scar (MS) for this exchange remains underexplored. RIs offer potential benefits by placing the incision at a region of higher quality tissue, prompting our comparative analysis of complications between RIs and MS.

METHODS

The authors retrospectively analyzed patients undergoing expander-to-implant exchange by means of RI or MS access from 2018 through 2023. Data on demographics, comorbidities, cancer characteristics, operations, therapies, and outcomes were collected from the electronic medical record, and complication rates were compared between RI and MS exchange procedures.

RESULTS

In propensity score-matched cohorts, overall complications (10% for MS and 7.5% for RI; P = 0.58), infection (5.0% for MS versus 2.5% for RI; P = 0.68), seroma (2.5% for both; P > 0.99), dehiscence (2.5% for both; P > 0.99), implant exposure (2.5% for MS versus 1.2% for RI; P > 0.99), and implant explantation (7.5% for MS versus 6.2% for RI; P = 0.75) were similar or lower in the RI group. Overall complications, infection, seroma, dehiscence, implant exposure, and explantation were also lower in irradiated patients receiving RI compared with MS exchanges, although the differences were statistically insignificant. Transaxillary and inframammary incisions showed comparable outcomes, with the latter having a higher incidence of infections.

CONCLUSION

RIs represent a safe alternative to MS exchanges in selected, high-risk patients undergoing postmastectomy implant-based breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.