Infection Following Implant-based Reconstruction in 1952 Consecutive Breast Reconstructions: Salvage Rates and Predictors of Success

Background: Few studies address salvage rates for infection in implant-based breast reconstruction. An understanding of success rates and clinical predictors of failure may help guide management.

Method: A retrospective analysis of multisurgeon consecutive implant reconstructions from 2004 to 2010 was performed.

Results: Immediate implant-based reconstructions (n=1952) were performed in 1241 patients. Ninety-nine reconstruction patients (5.1 percent) were admitted for breast erythema and had a higher incidence of smoking (p=0.007), chemotherapy (p=0.007), radiation therapy (p=0.001), and mastectomy skin necrosis (p<0.0001). There was no difference in age, body mass index, or acellular dermal matrix usage. With intravenous antibiotics, 25 (25.3 percent) reconstruction patients cleared the infection, whereas 74 (74.7 percent) underwent attempted operative salvage (n=18) or explantation (n=56). Patients who failed to clear infection had a higher mean white blood cell count at admission (p<0.0001). Of the attempted operative salvage group, 12 cleared the infection with immediate implant exchange and six eventually lost the implant. Patients who failed implant salvage were more likely to have methicillin-resistant Staphylococcus aureus (p=0.004). The total explantation rate was 3.2 percent. Following explantation, 32 patients underwent attempted secondary tissue expander insertion. Twenty-six were successful and six had recurrent infection and implant loss. There were no differences in time interval to tissue expander insertion between successful and unsuccessful secondary operations.

Conclusions: Salvage with intravenous antibiotics and implant exchange was successful in 37.3 percent of patients. Smoking, irradiation, chemotherapy, and mastectomy skin necrosis were predictors for developing infection. Patients with a higher white blood cell count at admission and methicillin-resistant S. aureus were more likely to fail implant salvage. There was no association with time interval to tissue expander insertion and secondary explantation.

Clinical Question/level Of Evidence: Therapeutic, IV.