Critical Evaluation of Risk Factors of Infection Following 2-Stage Implant-Based Breast Reconstruction

Abstract

Background:Infection is a dreaded complication following 2-stage implant-based breast reconstruction that can prolong the reconstructive process and lead to loss of implant. This study aimed to characterize outcomes of reconstructions complicated by infection, identify patient and surgical factors associated with infection, and use these to develop an infection management algorithm.Methods:We performed a retrospective review of all consecutive implant-based breast reconstructions performed by the senior author (2006–2015) and collected data regarding patient demographics, medical history, operative variables, presence of other complications (necrosis, seroma, hematoma), and infection characteristics. Univariate and multivariate binomial logistic regression analyses were performed to identify independent predictors of infection.Results:We captured 292 patients who underwent 469 breast reconstructions. In total, 14.1% (n = 66) of breasts were complicated by infection, 87.9% (n = 58) of those were admitted and given intravenous antibiotics, 80.3% (n = 53) of all infections were cleared after the first attempt, whereas the remaining recurred at least once. The most common outcome was explantation (40.9%; n = 27), followed by secondary implant insertion (21.2%; n = 14) and operative salvage (18.2%; n = 12). Logistic regression analysis demonstrated that body mass index (P = 0.01), preoperative radiation (P = 0.02), necrosis (P < 0.001), seroma (P < 0.001), and hematoma (P = 0.03) were independent predictors of infection.Conclusions:We observed an overall infectious complication rate of 14.1%. Heavier patients and patients who received preoperative radiation were more likely to develop infectious complications, suggesting that closer monitoring of high risk patients can potentially minimize infectious complications. Further, more aggressive management may be warranted for patients whose operations are complicated by necrosis, seroma, or hematoma.

Two-Staged Implant-Based Breast Reconstruction: A Long-Term Outcome Study in a Young Population

“…Using previously published data on IBR complications in the general population as a comparison, our younger population results show comparable complication rates [63,64,65,66]. In a systematic review published by Georgetown University Hospital in 2013, analysis of 679 two-staged IBRs demonstrated a pooled overall complication rate of 52.8% [67].…”

Antibiotic Prophylaxis in Alloplastic Breast Reconstruction: Regimens and Outcomes

“…This is consistent with the current literature. 2,18 -20 However, this is not a modifiable risk factor. Furthermore, the finding of larger expander/implant size as a risk factor for postop infection (OR: 1.41, CI: 1.05-1.90, P = .023) is also in agreement with the results of a cohort study by Selber et al 21…”

“…This is in line with what has been reported in the literature. 2 In this study, 2 common antibiotic prophylaxis regimens were compared. Evidently, an extended antibiotic prophylaxis regimen (> 7 days) was associated with a decreased rate of surgical site infection.…”

“…Rates of surgical site infection following TE/implant-based breast reconstruction are varied in the literature, ranging from 4.8% to 35.4%. 2 Part of this variability can be attributed to the numerous different perioperative antibiotic prescribing practices between surgeons.…”

Perioperative Complications in Plastic Surgery

“…Breast surgery-implants or reconstructions-body contouring procedures such as liposuction and abdominoplasty, or multiple procedures have been described with more risks of postoperative infections, especially if there are predisposing factors such as diabetes, HIV, cancer, or immunosuppressive treatment. Infections in plastic surgery can be minor due to microbial skin flora to severe cases affected with atypical or multiresistant opportunistic bacteria [70,71].…”