Postoperative Expansion is not a Primary Cause of Infection in Immediate Breast Reconstruction with Tissue Expanders

Avraham, Tomer; Weichman, K; Wilson, Stelios; Weinstein, Andrew A.; Haddock, Nicholas T.; Szpalski, Caroline; Choi, Mihye; Karp, Nolan S.

doi:10.1111/tbj.12448

Cited by 11 publications

(12 citation statements)

References 16 publications

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“…It is a common belief that the elderly are more susceptible to infection. [23,27] However, the mean age of our cohort was 42.3 ± 7.8 years old, ranging from 19 to 69, and 99% of them were younger than 60. This relatively low average age might explain why age did not influence the risk of infection in this study.…”

Section: Discussionmentioning

confidence: 81%

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Risk of infection is associated more with drain duration than daily drainage volume in prosthesis-based breast reconstruction

et al. 2016

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In prosthesis-based breast reconstruction, drains are used to prevent seroma formation and to reduce the risk of infection. However, prolonged drainage increases the risk of ascending infection. Although the volume often accepted for drain removal is ≤30 mL per day, the optimal timing to remove the drain for best clinical outcome remains controversial.We did a retrospective cohort study of 569 patients of prosthesis-based breast reconstruction with infection rate as the outcome variable; drain duration and last daily drainage volume as the main independent variables. Data on age, smoking history, diabetes mellitus history, body mass index, breast weight, tissue expander size, drain size, number of retrieved lymph nodes, tumor size, number of metastatic lymph nodes, tumor stage, mastectomy type, reconstruction type, submuscular implantation, skin defect, operative time, duration of antibiotics use, chemotherapy, and radiotherapy were collected as covariates. Multivariable logistic regression analysis was used to control for confounding.The total infection rate was 5.1% (29/569). The daily drainage volume ≥30 mL/d at the time of drain removal was not found associated with increased infection rate (P = 0.32). Of the various cutoff values of last daily drainage volume, none was found to be a determinant for drain removal where the risk of infection was concerned. By contrast, drain duration over 21 days significantly increased infection rate (P = 0.001). The multivariable logistic regression analysis showed an increase of 76.2% in the infection rate with each additional week of drain retention (P = 0.001). Breast weight also had a significant influence on risk of infection. Chemotherapy and drain size showed borderline effect on risk of infection whereas the last daily drainage volume was not associated with risk of infectionIn summary, our study revealed that drain duration, rather than the last daily drainage volume, significantly affects the infection rate in prosthesis-based breast reconstruction. We recommend that the drain is better removed no longer than 3 weeks postoperatively and can be removed as early as postoperative day 7, even when the drainage is over 30 mL in a 24-hour period.

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Section: Discussionmentioning

confidence: 81%

“…Greater initial tissue expander fill increased infection rate. [23] Crosby et al reported that for every 10% increase in saline fill volume, complication risk increased 1.15 times in univariable analysis ( P = 0.018). In their study, [24] the mean percentage of intraoperative tissue expander saline fill volume was 68%.…”

Section: Discussionmentioning

confidence: 99%

Risk of infection is associated more with drain duration than daily drainage volume in prosthesis-based breast reconstruction

et al. 2016

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“…In total, 102,000 breast reconstructions were performed in 2014 in the United States, 1 making it the fifth most common reconstructive procedure. 2 Of those, 72.5% were 2-stage implant-based reconstructions involving tissue expander (TE) and implant. 1 Infection is a dreaded complication of 2-stage implant-based breast reconstruction, as it can lead to loss of the implant, a prolonged reconstructive process, compromised aesthetic outcomes, and delayed oncologic treatment.…”

Section: Introductionmentioning

confidence: 99%

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

Long

Sue

Chattopadhyay

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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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.

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“…10,12 Indeed, careful patient selection to mitigate demonstrated risk factors is important. Patient comorbidities, adjuvant therapies, body mass index (BMI), and breast weight/implant size are a few factors that have been shown to be associated with higher postoperative complication rates.…”

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confidence: 99%

“…Patient comorbidities, adjuvant therapies, body mass index (BMI), and breast weight/implant size are a few factors that have been shown to be associated with higher postoperative complication rates. 12–18 It has also been demonstrated that total complication rates decrease as surgeons become more experienced with ADM-assisted breast procedures, indicating that there is a certain “learning curve” to the technique. 15,19 …”

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confidence: 99%

Complication Rates With Human Acellular Dermal Matrices: Retrospective Review of 211 Consecutive Breast Reconstructions

Schnarrs

Carman

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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Background:Human acellular dermal matrix (HADM) is commonly used to provide coverage and support for breast reconstruction. The primary purpose of this study was to evaluate the complication rates associated with breast reconstruction procedures when performed in conjunction with multiple types of HADM in a consecutive series.Methods:After receiving institutional review board approval, medical records from a single surgeon were retrospectively reviewed for 126 consecutive patients (170 breasts and 211 procedures) who received a breast reconstruction or revision with implantation of HADM between 2012 and 2014. Patient demographics, surgical technique, and the complication profile of 4 major types of HADM were evaluated by procedure. Complication data were primarily evaluated for infection, seroma formation, necrosis, and other complications requiring additional surgery.Results:The total complication rate was 19.4%. The complication rates were not statistically different between all 4 types of HADM: Alloderm (n = 143); Alloderm RTU (n = 19); FlexHD (n = 18); hMatrix (n = 32) (P > 0.05). Smokers and large-breasted women (≥500 g) had a significantly higher complication rate than the rest of the population (P < 0.01 and P < 0.03, respectively). The complication rates associated with all other patient cohorts analyzed (age, body mass index, comorbid conditions, cancer diagnosis, prepectoral technique) showed no influence on complication rates (P > 0.05).Conclusions:In characteristically similar cohorts, there was no statistically significant difference in complication rates based on type of HADM; however, certain risk factors and anatomy should be considered before HADM-assisted breast reconstruction.

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Postoperative Expansion is not a Primary Cause of Infection in Immediate Breast Reconstruction with Tissue Expanders

Cited by 11 publications

References 16 publications

Risk of infection is associated more with drain duration than daily drainage volume in prosthesis-based breast reconstruction

Risk of infection is associated more with drain duration than daily drainage volume in prosthesis-based breast reconstruction

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

Complication Rates With Human Acellular Dermal Matrices: Retrospective Review of 211 Consecutive Breast Reconstructions

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