Smooth Operator: Nanotextured Breast Tissue Expanders Are Associated with Lower Rates of Capsular Contracture

Overview

Journal J Clin Med

Specialty General Medicine

Date 2024 Oct 16

PMID 39407864

Authors

Armin Catic

Andrea Weinzierl

Jakob Heimer

Barbara Pompei

Yves Harder

Affiliations

Soon will be listed here.

Abstract

Continuous research on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has introduced a focus on surface texturizations and a shift towards smooth breast devices, yet outcomes comparing the complication profiles of differently textured tissue expanders (TEs) remain conflicting. The study aim was to compare the complication profile of a new nanotextured and MRI-compatible TE to micro- and macrotextured TEs and to identify possible predictors for complications. A retrospective analysis of women undergoing expander-based breast reconstruction after mastectomy between January 2016 and March 2022 was conducted. The primary endpoint was the development of capsular contracture. Possible predictors were analyzed in a mixed-effects model using the least absolute shrinkage and selection operator (LASSO). Moreover, a comparison of complications and an evaluation of predictors were carried out. A total of 147 breasts, encompassing 82 nanotextured, 43 microtextured and 22 macrotextured TEs, were analyzed. Breasts with nanotextured TEs were less likely to develop capsular contracture overall (OR, 0.12; 95%CI 0.05-0.28, < 0.001). Post-mastectomy radiotherapy (PMRT) was identified as a predictor for capsular contracture (OR, 4.67; 95%CI 1.86-11.71, < 0.001). Breasts with nanotextured TEs showed a higher rate of seroma, but lower rates of malposition and pain. Predictors for developing postoperative complications included higher mastectomy weight ( = 0.008). Breasts with nanotextured TEs exhibited the lowest rate of capsular contracture compared to micro- and macrotextured TEs. Together with its MRI-compatibility and improved oncologic follow-up, the nanotextured TE seems to be a favorable device for expander-based breast reconstruction.

References

Lee K, Park H, Jeon B, Mun G, Bang S, Pyon J . Does the Textured-Type Tissue Expander Affect the Outcomes of Two-Stage Prosthetic Breast Reconstruction? A Propensity Score Matching Analysis between Macrotextured and Microtextured Expanders. Plast Reconstr Surg. 2021; 147(3):545-555. DOI: 10.1097/PRS.0000000000007634. View

Wilkins E, Cederna P, Lowery J, Davis J, Kim H, Roth R . Prospective analysis of psychosocial outcomes in breast reconstruction: one-year postoperative results from the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg. 2000; 106(5):1014-25; discussion 1026-7. DOI: 10.1097/00006534-200010000-00010. View

Schoberleitner I, Augustin A, Egle D, Brunner C, Amort B, Zelger B . Is It All about Surface Topography? An Intra-Individual Clinical Outcome Analysis of Two Different Implant Surfaces in Breast Reconstruction. J Clin Med. 2023; 12(4). PMC: 9967160. DOI: 10.3390/jcm12041315. View

Chiu W, Fracol M, Feld L, Qiu C, Kim J . Judging an Expander by Its Cover: A Propensity-Matched Analysis of the Impact of Tissue Expander Surface Texture on First-Stage Breast Reconstruction Outcomes. Plast Reconstr Surg. 2020; 147(1):1e-6e. DOI: 10.1097/PRS.0000000000007417. View

Eltahir Y, Werners L, Dreise M, Zeijlmans van Emmichoven I, Jansen L, Werker P . Reply: quality-of-life outcomes between mastectomy alone and breast reconstruction: comparison of patient-reported breast-Q and other health-related quality-of-life measures. Plast Reconstr Surg. 2014; 133(4):595e. DOI: 10.1097/PRS.0000000000000041. View

Sue G, Sun B, Lee G . Complications After Two-Stage Expander Implant Breast Reconstruction Requiring Reoperation: A Critical Analysis of Outcomes. Ann Plast Surg. 2018; 80(5S Suppl 5):S292-S294. DOI: 10.1097/SAP.0000000000001382. View

Di Valerio E, Rao A, Leyngold M, Carlson J, ONeill D, Virk S . Outcomes Analysis of Textured Versus Smooth Tissue Expanders in Breast Reconstruction. Ann Plast Surg. 2022; 89(6):622-625. DOI: 10.1097/SAP.0000000000003330. View

Berniz C, Carmona-Torre F, Gomez-Martinez C, Fernendez-Ciriza L, Del Pozo J, Hontanilla B . Breast Implant Capsule: A Murine Model Comparing Capsular Contracture Susceptibility Among Six Breast Implants Available in the Market. Aesthetic Plast Surg. 2023; 47(5):2093-2105. PMC: 10582141. DOI: 10.1007/s00266-023-03323-0. View

Weinzierl A, Schmauss D, Brucato D, Harder Y . Implant-Based Breast Reconstruction after Mastectomy, from the Subpectoral to the Prepectoral Approach: An Evidence-Based Change of Mind?. J Clin Med. 2022; 11(11). PMC: 9181810. DOI: 10.3390/jcm11113079. View

10.

Otte M, Nestle-Kramling C, Fertsch S, Hagouan M, Munder B, Richrath P . Conservative mastectomies and Immediate-DElayed AutoLogous (IDEAL) breast reconstruction: the DIEP flap. Gland Surg. 2016; 5(1):24-31. PMC: 4716867. DOI: 10.3978/j.issn.2227-684X.2015.05.15. View

11.

Corban J, Shash H, Safran T, Sheppard-Jones N, Fouda-Neel O . A systematic review of complications associated with direct implants vs. tissue expanders following Wise pattern skin-sparing mastectomy. J Plast Reconstr Aesthet Surg. 2017; 70(9):1191-1199. DOI: 10.1016/j.bjps.2017.02.028. View

12.

Siggelkow W, Faridi A, Spiritus K, Klinge U, Rath W, Klosterhalfen B . Histological analysis of silicone breast implant capsules and correlation with capsular contracture. Biomaterials. 2002; 24(6):1101-9. DOI: 10.1016/s0142-9612(02)00429-5. View

13.

Serletti J, Fosnot J, Nelson J, Disa J, Bucky L . Breast reconstruction after breast cancer. Plast Reconstr Surg. 2011; 127(6):124e-135e. DOI: 10.1097/PRS.0b013e318213a2e6. View

14.

McLaughlin C, Hughes A, Parham C, Fritsche M, Potochny J, Kunselman A . Smooth Versus Textured Tissue Expander Breast Reconstruction: Complications and Efficacy. Ann Plast Surg. 2022; 88(3 Suppl 3):S288-S292. DOI: 10.1097/SAP.0000000000003193. View

15.

Elder E, Brandberg Y, Bjorklund T, Rylander R, Lagergren J, Jurell G . Quality of life and patient satisfaction in breast cancer patients after immediate breast reconstruction: a prospective study. Breast. 2005; 14(3):201-8. DOI: 10.1016/j.breast.2004.10.008. View

16.

Doloff J, Veiseh O, Mezerville R, Sforza M, Perry T, Haupt J . The surface topography of silicone breast implants mediates the foreign body response in mice, rabbits and humans. Nat Biomed Eng. 2021; 5(10):1115-1130. DOI: 10.1038/s41551-021-00739-4. View

17.

Shiokawa I, Sato T, Ogawa Y, Nagasaka Y, Ishikawa A, Shimada S . Tissue Expander-associated T Cells: Relevance to Breast Implant-associated Anaplastic Large-cell Lymphoma. Plast Reconstr Surg Glob Open. 2022; 10(3):e4148. PMC: 8942776. DOI: 10.1097/GOX.0000000000004148. View

18.

Lovecchio F, Jordan S, Lim S, Fine N, Kim J . Risk Factors for Complications Differ Between Stages of Tissue-Expander Breast Reconstruction. Ann Plast Surg. 2014; 75(3):275-80. DOI: 10.1097/SAP.0000000000000109. View

19.

Schiaffino S, Cozzi A, Pompei B, Scarano A, Catanese C, Catic A . MRI-Conditional Breast Tissue Expander: First In-Human Multi-Case Assessment of MRI-Related Complications and Image Quality. J Clin Med. 2023; 12(13). PMC: 10342840. DOI: 10.3390/jcm12134410. View

20.

Shammas R, Cason R, Sergesketter A, Glener A, Broadwater G, Hollins A . A Comparison of Surgical Complications in Patients Undergoing Delayed versus Staged Tissue-Expander and Free-Flap Breast Reconstruction. Plast Reconstr Surg. 2021; 148(3):501-509. DOI: 10.1097/PRS.0000000000008208. View