Reducing infection risk in implant-based breast-reconstruction surgery: challenges and solutions<div><br /></div>

Abstract

Implant-based procedures are the most commonly performed method for postmastectomy breast reconstruction. While donor-site morbidity is low, these procedures are associated with a higher risk of reconstructive loss. Many of these are related to infection of the implant, which can lead to prolonged antibiotic treatment, undesired additional surgical procedures, and unsatisfactory results. This review combines a summary of the recent literature regarding implant-related breast-reconstruction infections and combines this with a practical approach to the patient and surgery aimed at reducing this risk. Prevention of infection begins with appropriate reconstructive choice based on an assessment and optimization of risk factors. These include patient and disease characteristics, such as smoking, obesity, large breast size, and immediate reconstructive procedures, as well as adjuvant therapy, such as radiotherapy and chemotherapy. For implant-based breast reconstruction, preoperative planning and organization is key to reducing infection. A logical and consistent intraoperative and postoperative surgical protocol, including appropriate antibiotic choice, mastectomy-pocket creation, implant handling, and considered acellular dermal matrix use contribute toward the reduction of breast-implant infections.

Surveillance and Prevention of Surgical Site Infections in Breast Oncologic Surgery with Immediate Reconstruction

“…[113, 115, 116] Khansa and colleagues included irrigation and soaking of implants in a triple antibiotic solution in a standardized protocol to minimize infection risk in tissue expander reconstruction. [66] The protocol also included chlorhexidine bathing the day before and morning of surgery, surgical site antisepsis with chlorhexidine, and prescription of oral antibiotics for prophylaxis post-discharge until drains were removed.…”

The Impact of Closed Incision Negative Pressure Therapy on Postoperative Breast Reconstruction Outcomes

“…1 Implant-based breast reconstructions continue to be the most popular option, accounting for nearly 80% of procedures. 2 , 3 Reasons for increased implant-based breast reconstruction procedures include no donor-site morbidity, shorter procedure times, a younger patient population, a lack of autologous donor tissue, and an increase in the number of bilateral mastectomies. 2 – 4 …”

Comprehensive Preventive Approach to Surgical Site Infections (SSIs): A Review

“…Age increasing (1, 2, 9) and diabetes mellitus (2, 9, 10), (significant relationships have been demonstrated between increased level of HgA1c and SSI rates) (11), postoperative anemia (12), obesity (BMI > 30) and overweight (9,10,13,14), malnutrition (defined as significant weight loss 6 months prior to surgery) (2,10,15), stress (eg. due to fear or delayed surgery), renal insufficiency (creatinine < 2 mg/dL) (10), cigarette smoking (10,15,16), (cigarette smoking leading to tissue hypovolemia and hypoxia) (11), alcohol overuse (14,17), cirrhosis (10), hypothermia (18), hypoxemia, (oxygen saturation less than 50% was identified as an independent risk factor for SSI) (9), low serum albumin/ hypoproteinemia (12), necrosis of operated area, malignant disease (10,12,16), COPD (chronic obstructive pulmonary disease) (10), decreased immunity/ having immunological disorders (1,16), use of corticosteroids (e.g.…”

“…due to fear or delayed surgery), renal insufficiency (creatinine < 2 mg/dL) (10), cigarette smoking (10,15,16), (cigarette smoking leading to tissue hypovolemia and hypoxia) (11), alcohol overuse (14,17), cirrhosis (10), hypothermia (18), hypoxemia, (oxygen saturation less than 50% was identified as an independent risk factor for SSI) (9), low serum albumin/ hypoproteinemia (12), necrosis of operated area, malignant disease (10,12,16), COPD (chronic obstructive pulmonary disease) (10), decreased immunity/ having immunological disorders (1,16), use of corticosteroids (e.g. following gastrointestinal surgery) (19), history of broad-spectrum antibiotics, 3-months before the surgery, chemotherapy and radiotherapy (e.g.…”

“…following gastrointestinal surgery) (19), history of broad-spectrum antibiotics, 3-months before the surgery, chemotherapy and radiotherapy (e.g. breast-reconstruction surgery) (15), postoperative transfusion (20), excessive blood loss (11), coexistent infections (e.g. Peritonitis) (2,12), colonization of the surgical site with bacteria (11), super imposed infections on chronic skin diseases such as psoriasis, eczema, etc., patient flora, patient nasal carrier state of staphylococcus sp.…”