Infection following Implant-Based Reconstruction in 1952 Consecutive Breast Reconstructions

Reish, Richard G.; Damjanovic, Branimir; Austen, William G.; Winograd, Jonathan M.; Liao, Eric C.; Cetrulo, Curtis L.; Balkin, Daniel M.; Colwell, Amy S.

doi:10.1097/prs.0b013e31828bd377

Cited by 145 publications

(172 citation statements)

References 17 publications

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“…The classification of the infection degree was performed in all seven studies; and even though this stratification was not uniform, the advanced level was among the main causes of prosthetic loss. In four studies, the severity of infection implicated in removal of the prosthesis and late reconstruction, in case the patient desired so [13][14][15][16][17][18][19] . The rate of saved prostheses after stratification of complications -including the use of the same prosthesis or its replacement by another device -varied from 45 to 100%.…”

Section: Resultsmentioning

confidence: 99%

“…Three of the seven studies with direct data presented positive Gram-bacteria of the skin as a statistically significant factor of non-success among the attempts of saving the prostheses 13,15,19 , and Staphylococcus Aureus was the most responsible one for it. Radiotherapy appears in second place as the cause of implant loss.…”

Section: Yii and Khoomentioning

confidence: 99%

“…Reish et al 13 have developed the study with the largest selection of cases, in which 1,952 patients who had their breasts If the quality of the remaining skin was poor, then the prosthesis was removed, the infection was controlled, and late reconstruction was performed. Managements to save the prosthesis include washing with antibiotics, capsulectomy, change of device, and primary or combined closure with muscular flap.…”

Section: Retrospective 1995 To 2000mentioning

confidence: 99%

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Management of complications in reconstructive mammoplasties with prostheses: systematic review

Hassan¹,

Urban²

2017

Rev. Bras. Mastol. (Impr.)

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Objective: The aims of this study were to determine the main managements of surgical complications in reconstructive mammoplasties with prostheses through a systematic literature review, and to evaluate the effectiveness in preserving the reconstruction. The secondary objective was to analyze factors regarding prosthetic loss. Methods: We used the MedLine database through the following expressions: "breast cancer" or "breast neoplasm" or "breast and neoplasm" or "breast and cancer" and "implants complications" or "implants and complications". The reference period for these studies comprised January 2000 to July 2016. Results: Of the 856 articles found, seven were included to analyze the applied protocols. The rate of saved prostheses after stratification of complications and use of managements varied from 45 to 100%, depending on the degree of complication. Other 12 articles that evaluated the factors associated with prosthetic loss were secondarily chosen. Radiotherapy was considered the most frequent factor and was found in seven studies. The number of lost prostheses varied from 0.9 to 22.7% in such studies. Conclusion: There is still no agreement on how to manage complications of reconstructive mammoplasties with prostheses. The decision remains a challenge, and therefore surgeons need to know the possible conducts in order to establish the most appropriate treatment.KEYWORDS: Breast cancer; mastectomy; mammaplasty; breast implantation. ABSTRACT RESUMOObjetivos: O objetivo principal deste estudo foi determinar, por meio de revisão sistemática da literatura, as principais condutas nas complicações cirúrgicas de mastectomias reconstruídas com próteses, bem como avaliar a eficácia em preservar a reconstrução. O objetivo secundário foi analisar fatores relacionados à perda da prótese. Métodos: Foi empregado o banco de dados do MedLine, utilizando as expressões: breast cancer, ou breast neoplasm ou breast and neoplasm ou breast and cancer e implants complications ou implants and complications. O período de referência desses estudos foi de janeiro de 2000 até julho de 2016. Resultados: Dos 856 artigos encontrados, 7 foram incluídos para análise dos protocolos de condutas aplicados. A taxa de próteses salvas após estratificação das complicações e aplicação das condutas variou de 45 a 100%, a depender do grau de complexidade. Foram selecionados, secundariamente, outros 12 artigos que avaliaram fatores associados à perda da prótese. A mais frequente foi a radioterapia com 7 estudos. O número de próteses perdidas variou entre 0,9 e 22,7% nesses estudos. Conclusão: Ainda não existe unanimidade no manejo das complicações de mastectomias reconstruídas com próteses. Portanto, a decisão permanece desafiadora e o cirurgião necessita conhecer as possíveis condutas para definir a mais apropriada. PALAVRAS-CHAVE:Câncer de mama; mastectomia; reconstrução da mama; implante de mama. REVIEW ARTICLEMastology, 2017;27(2):156-63 157Management of complications in reconstructive mammoplasties with prostheses: systematic review

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Section: Resultsmentioning

confidence: 99%

Section: Yii and Khoomentioning

confidence: 99%

Section: Retrospective 1995 To 2000mentioning

confidence: 99%

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Management of complications in reconstructive mammoplasties with prostheses: systematic review

Hassan¹,

Urban²

2017

Rev. Bras. Mastol. (Impr.)

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“…Breast fluid collections mostly develop in the pre-pectoral space, 18 however use of ADM has been reported to increase peri-prosthetic fluid volumes, and seroma duration. 17 Strategies which aim to salvage infected breast implants are well covered in the literature 1,14,15,19 and this paper will not expand on this further.…”

Section: Case Presentationmentioning

confidence: 99%

“…14 The presence of a raised white cell count, a history of previous radiotherapy to the breast or the culture of atypical bacteria (e.g., gram negative rods or methicillin resistant S. aureus) are reportedly associated with higher implant loss rates. 15 There is some controversy in the literature as to whether the inclusion of biological matrices, particularly acellular dermal matrix (ADM) around the implant [14][15][16][17] may increase the risks of peri-prosthetic infection. Use of ADM has been associated with the phenomenon of "red breast syndrome", 14 painless blanching erythema, which is not infectious in origin and is self limiting over weeks to months.…”

Section: Case Presentationmentioning

confidence: 99%

A surgeon, a rabbi and a lawyer walk in to an OR… Absorbable haemostatic agents and the dangers of product evolution – clinical, religious and legal implications

Gluch¹

2018

AMJ

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Please cite this paper as: Gluch L, Gluch N. A surgeon, a rabbi and a lawyer walk into an OR… Absorbable haemostatic agents and the dangers of product evolutionclinical, religious and legal implications. AMJ 2018;11 (1) ABSTRACTAdjunctive haemostatic agents have been used in surgery for over 70 years. What surgeons may not know is that products intended for similar applications may have very different biological properties and that occasionally product upgrades may introduce a change in the material's behaviour. Many of the agents employed to assist in haemostasis may have a biological (animal) origin. A recent case brought to light the need to recognise the possibility of biological interactions. As consideration into this surgical problem unfolded, religious and legal questions began to arise. Key WordsBreast reconstruction, haemostatics, adverse effects Implications for Practice: What is known about this subject?This case suggests the possibility that some "inert" haemostatic agents may result in allergic type reactions. It has not previously been reported. What new information is offered in this case study?The complex biological origin of haemostatic agents and the biological, religious and legal implications of using them.3. What are the implications for research, policy, or practice?

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Effectiveness of Single vs Multiple Doses of Prophylactic Intravenous Antibiotics in Implant-Based Breast Reconstruction

et al. 2022

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IMPORTANCE Multiple-dose antibiotic prophylaxis is widely used to prevent infection after implantbased breast reconstruction despite the lack of high-level evidence regarding its clinical benefit. OBJECTIVE To determine whether multiple-dose antibiotic prophylaxis is superior to single-dose antibiotic prophylaxis in preventing surgical site infection (SSI) after implant-based breast reconstruction. DESIGN, SETTING, AND PARTICIPANTS This prospective, multicenter, randomized clinical superiority trial was conducted at 7 hospitals (8 departments) in Sweden from April 25, 2013, to October 31, 2018. Eligible participants were women aged 18 years or older who were planned to undergo immediate or delayed implant-based breast reconstruction. Follow-up time was 12 months. Data analysis was performed from May to October 2021. INTERVENTIONS Multiple-dose intravenous antibiotic prophylaxis extending over 24 hoursfollowing surgery, compared with single-dose intravenous antibiotic. The first-choice drug was cloxacillin (2 g per dose). Clindamycin was used (600 mg per dose) for patients with penicillin allergy. MAIN OUTCOMES AND MEASURESThe primary outcome was SSI leading to surgical removal of the implant within 6 months after surgery. Secondary outcomes were the rate of SSIs necessitating readmission and administration of intravenous antibiotics, and clinically suspected SSIs not necessitating readmission but oral antibiotics. RESULTSA total of 711 women were assessed for eligibility, and 698 were randomized (345 to single-dose and 353 to multiple-dose antibiotics). The median (range) age was 47 (19-78) years for those in the multiple-dose group and 46 (25-76) years for those in the single-dose group. The median (range) body mass index was 23 (18-38) for the single-dose group and 23 (17-37) for the multipledose group. Within 6 months of follow-up, 30 patients (4.3%) had their implant removed because of SSI. Readmission for intravenous antibiotics because of SSI occurred in 47 patients (7.0%), and 190 women (27.7%) received oral antibiotics because of clinically suspected SSI. There was no significant difference between the randomization groups for the primary outcome implant removal (odds ratio [OR], 1.26; 95% CI, 0.69-2.65; P = .53), or for the secondary outcomes readmission for intravenous antibiotics (OR, 1.18; 95% CI, 0.65-2.15; P = .58) and prescription of oral antibiotics (OR, 0.72; 95% CI, 0.51-1.02; P = .07). Adverse events associated with antibiotic treatment were more common in the multiple-dose group than in the single-dose group (16.4% [58 patients] vs 10.7% [37 patients]; OR, 1.64; 95% CI, 1.05-2.55; P= .03).

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Infection following Implant-Based Reconstruction in 1952 Consecutive Breast Reconstructions

Abstract: Therapeutic, IV.

Cited by 145 publications

References 17 publications

Management of complications in reconstructive mammoplasties with prostheses: systematic review

Management of complications in reconstructive mammoplasties with prostheses: systematic review

A surgeon, a rabbi and a lawyer walk in to an OR… Absorbable haemostatic agents and the dangers of product evolution – clinical, religious and legal implications

Effectiveness of Single vs Multiple Doses of Prophylactic Intravenous Antibiotics in Implant-Based Breast Reconstruction

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