P46. COMPLICATIONS IN PREPECTORAL TISSUE EXPANDER PLACEMENT: A SINGLE INSTITUTION STUDY

Abstract

PURPOSE: Prepectoral two-stage post-mastectomy breast reconstruction has increased in the recent time period. Benefits of prepectoral reconstruction may include lack of animation deformities and reduced post-operative pain, but its complication profile is currently unclear. The aim of this study is to examine the complication profile of prepectoral tissue expanders (TEs) at our institution. METHODS: We performed a retrospective review of patients who underwent immediate reconstruction with a prepectoral TE from 2018-2020 at Memorial Sloan Kettering Cancer Center. Basic demographics and comorbidities were evaluated. Outcomes of interest included seroma, hematoma, infection/cellulitis, mastectomy skin flap necrosis requiring revision (MSFN), TE exposure, capsular contracture, and TE loss. Multivariate logistic regression assessed factors associated with increased odds of TE loss. RESULTS: A total of 574 patients (952 TEs) were included. Overall, 78.6% of mastectomies were skin-sparing, 71.2% of TEs were smooth, 82.6% used acellular dermal matrix (ADM), and 46.6% used SPY angiography. Most frequent complications were seroma (9%), infection/cellulitis (8%), and TE loss (4.6%). Hematoma, TE exposure, and MSFN each had complication rates of 2%. Fewer than 1% of patients experienced capsular contracture. Diabetics (OR=1.09, p=0.02), former smokers (OR=2.45, p<0.01), and increasing mastectomy weight (OR=0.001, p=0.04) had increased odds of TE loss. TE loss was not associated with TE surface type, ADM use, or SPY use. CONCLUSION: Prepectoral reconstruction is a reasonable and safe alternative to subpectoral TE placement. Further research examining the quality of the soft tissue envelope and pocket size, as well as assessment of patient reported outcomes, would prove beneficial.