Purpose In an attempt to reduce the incidence of infectious complications after tissue expander–based breast reconstruction, the routine administration of postoperative antibiotics regimen is common in many practices. In recent years, there has been a plethora of reports scrutinizing the prophylactic use of postoperative antibiotics in this setting. The aim of this study was to determine the efficacy of prolonged administration of postoperative antibiotics compared with perioperative-only antibiotic administration for prophylaxis after tissue expander placement for immediate mastectomy reconstruction. Methods and Materials A retrospective chart review of all patients who underwent immediate tissue expander placement after mastectomy at our institution from June 2005 to September 2018 was performed. All patients in the study received perioperative intravenous antibiotics 30 to 60 min preoperatively and for 24 hours postoperatively. Patients were divided into 2 groups. Patients in group A did not receive antibiotics beyond the perioperative period. Patients in group B received oral antibiotics for at least 7 days postoperatively in addition to the perioperative intravenous antibiotics. The 2 groups were compared for demographics and prevalence of risk factors such as radiation, chemotherapy, smoking, and diabetes. The incidence of complications such as infection, wound complications, hematoma, seroma, capsular contracture, loss of tissue expander, and reoperations was assessed. Summary of Results A total of 529 patients were included in the study, of which 241 were in group A and 288 were in group B. The total number of breasts reconstructed in group A was 398, whereas in group B, it was 466 breasts. Patients were followed up to 5 months postoperatively in each group. There were no statistically significant differences in the demographic and patient characteristics among the 2 groups. The incidence of infection in group A was 23.24% and in group B was 21.53% (P = 0.412). The incidence of other complications follows the same trend when comparing group A versus B. Conclusions This retrospective study shows that the routine use of postoperative antibiotics after tissue expander placement for immediate mastectomy reconstruction does not result in reduction in the incidence of common complications or improvement of clinical outcomes.
We present a case of a 60-year-old woman with chronic lower abdominal pain and green urine. Further workup revealed a cholecystovesicular fistula (CVF), a newly coined term to indicate a fistula between the gallbladder and the urinary bladder. The CVF was treated surgically. The pathophysiology of CVF is thought to result from gallbladder perforation into the liver. Over time, a tract forms inferiorly until it meets another organ, in this case, the urinary bladder. This later complication of the gallbladder disease joins the broader spectrum of cholecystic fistulas. To our knowledge, a CVF has never been reported in the literature.
447 patients (573 breasts), stratified by duration of postoperative antibiotic prophylaxis (1 day, 14 days, or 21 days). Patient data were abstracted from medical records. Multivariable-adjusted logistic regression with robust variances was used to identify predictors of postoperative surgical site infections. All statistical analyses were completed using Stata v.15, and the two-tailed threshold for statistical significance was 0.05. RESULTS:Patients across the three study cohorts (1, 14, and 21 days of postoperative antibiotic prophylaxis) were well-matched with regard to baseline demographic/clinical factors. Patients were separated into high risk (eg, smoker, diabetic) and standard risk groups with regard to their risk for postoperative infection (infection rates: 22.2% in high risk group versus 9.7% in low risk group, respectively, chi square: P = 0.02). Amongst standard risk patients, infection rates significantly differed by antibiotic duration (1 day: 15.2%, 14 days: 7.9% and 21 days: 5.4%, respectively, chi square: P = 0.003). Upon univariable and multivariable analyses, the 14-day cohort (adjusted odds ratio: 0.5, 95% confidence interval: 0.2-1.0, P = 0.05) had significantly reduced odds of infection compared with the 24-hour cohort. Twenty-one days of antibiotics, however, did not provide any additional benefit over 14 days. In contrast, amongst "high-risk" patients, duration of postoperative antibiotics did not influence infection rates (chi square: P = 0.98). In fact, upon univariable and multivariable analyses adjusting for baseline differences amongst patient cohorts, neither 14-day (adjusted odds ratio: 1.2, 95% confidence interval: 0.1-9.5, P = 0.89) nor 21-day cohorts (adjusted odds ratio: 1.1, 95% confidence interval: 0.1-10.0, P = 0.90) had significantly reduced odds of postoperative infection among "high risk" patients, when compared with the 24-hour cohort. Across all patients, incidence of postoperative complications other than infection and its sequelae was 20.7%. Overall complication rates did not significantly differ between study cohorts (chi square: P = 0.51). CONCLUSIONS:Two stage tissue expander/implantbased techniques remain the predominant form of postmastectomy breast reconstruction. Thus, it is important to determine ways to continue improving outcomes for patients undergoing this type of breast reconstruction, especially in the prepectoral plane. In standard risk patients, extending postoperative antibiotic prophylaxis beyond 1 day significantly reduced infection rates after prepectoral tissue expander placement, although continuing antibiotics prophylaxis beyond 14 days did not confer additional clinical benefits. Among high risk patients, however, alternative strategies for infection control need to be investigated.
Phyllodes tumors are uncommon fibroepithelial tumors of the breast. These tumors are graded based on the World Health Organization criteria into benign, borderline, and malignant subtypes. While benign phyllodes tumors are by far the most common presentation, borderline and malignant tumors have important clinical implications, as they are more likely to locally recur and metastasize. The most common sites of distant metastasis include the lung, bone, heart, and liver. Rare spread to the small intestines, kidney and pelvis have also been reported. We report a case of a 71 year-old woman with a history of locally recurrent phyllodes tumor of the breasts found to have retroperitoneal and intraperitoneal metastases. The retroperitoneal mass was just below the left kidney, extending into the pelvis, and overlying the psoas and iliacus. The second mass involved the second portion of the duodenum, the proximal transverse colon, and the overlying mesentery. This case of delayed metastatic spread of phyllodes tumor to two sites, seventeen years after first presentation, represent a rare case.
Phyllodes tumors are uncommon fibroepithelial tumors of the breast. These tumors are graded based on the World Health Organization criteria into benign, borderline, and malignant subtypes. While benign phyllodes tumors are by far the most common presentation, borderline and malignant tumors have important clinical implications, as they are more likely to locally recur and metastasize. The most common sites of distant metastasis include the lung, bone, heart, and liver. Rare spread to the small intestines, kidney and pelvis have also been reported. We report a case of a 71-year-old woman with a history of locally recurrent phyllodes tumor of the breasts found to have retroperitoneal and intraperitoneal metastases. The retroperitoneal mass was just below the left kidney, extending into the pelvis, and overlying the psoas and iliacus muscle. The second mass involved the second portion of the duodenum, the proximal transverse colon, and the overlying mesentery. This is a rare case of delayed metastatic spread of phyllodes tumor to two sites, seventeen years after first presentation.
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