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

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Two-stage prosthetic breast reconstruction involves the exchange of tissue expanders for implants, but complications of this procedure can necessitate revision surgeries and implant removal. The choice between remote incision (RI) and traditional access via existing mastectomy scars (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 RI and MS. We retrospectively analysed patients undergoing expander-to-implant exchange via RI or MS access during 2018 through 2023. Data on demographics, comorbidities, cancer characteristics, surgeries, therapies, and outcomes were collected from the electronic medical record, and complication rates were compared between RI and MS exchange procedures. In propensity-score matched cohorts, overall complications (10% for MS and 7.5% for RI, p = 0.58), infection (5.0% for MS vs. 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 vs. 1.2% for RI, p>0.99), and implant explantation (7.5% for MS vs. 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 radiated patients receiving RI compared to MS exchanges, though statistically insignificant. Transaxillary and inframammary incisions showed comparable outcomes, albeit the latter having a higher incidence of infections. RIs represent a safe alternative to MS exchanges in selected, high-risk patients undergoing post-mastectomy implant-based breast reconstruction.