Late Surgical-Site Infection in Immediate Implant-Based Breast Reconstruction

Overview

Journal Plast Reconstr Surg

Specialty General Surgery

Date 2016 Dec 28

PMID 28027221

Citations 28

Authors

Indranil Sinha

Andrea L Pusic

Edwin G Wilkins

Jennifer B Hamill

Xiaoxue Chen

Hyungjin M Kim

Gretchen Guldbrandsen

Yoon S Chun

Affiliations

Soon will be listed here.

Abstract

Background: Surgical-site infection causes devastating reconstructive failure in implant-based breast reconstructions. Large national database studies offer insights into complication rates, but only capture outcomes within 30 days postoperatively. This study evaluates both early and late surgical-site infection in immediate implant-based reconstruction and identifies predictors.

Methods: As part of the Mastectomy Reconstruction Outcomes Consortium Study, 1662 implant-based breast reconstructions in 1024 patients were evaluated for early versus late surgical-site infection. Early surgical-site infection was defined as infection occurring within 30 days postoperatively; late surgical-site infection was defined as infection occurring 31 days to 1 year postoperatively. Minor infection required oral antibiotics only, and major infection required hospitalization and/or surgical treatment. Direct-to-implant patients had 1-year follow-up, and tissue expander patients had 1-year post-exchange follow-up.

Results: Among 1491 tissue expander and 171 direct-to-implant reconstructions, overall surgical-site infection rate for tissue expander was 5.7 percent (85 of 1491) after first-stage, 2.5 percent (31 of 1266) after second-stage, and 9.9 percent (17 of 171) for direct-to-implant reconstruction. Over 47 to 71 percent of surgical-site infection complications were late surgical-site infection. Multivariate analysis identified radiotherapy and increasing body mass index as significant predictors of late surgical-site infection. No significant difference between the direct-to-implant and tissue expander groups in the occurrence of early, late, or overall surgical-site infection was found.

Conclusions: The majority of surgical-site infection complications in immediate implant-based breast reconstructions occur more than 30 days after both first-stage and second-stage procedures. Radiotherapy and obesity are significantly associated with late-onset surgical-site infection. Current studies limited to early complications do not present a complete assessment of infection associated with implant-based breast reconstructions or their long-term clinical outcomes.

Clinical Question/level Of Evidence: Risk, II.

Citing Articles

Conversion from Alloplastic to Autologous Breast Reconstruction: What Are the Inciting Factors?.

Bitoiu B, Schlagintweit S, Zhang Z, Bovill E, Isaac K, Macadam S Plast Surg (Oakv). 2024; 32(2):213-219.

PMID: 38681249 PMC: 11046274. DOI: 10.1177/22925503221107214.

Comorbid Conditions and Complications in Body Contouring Surgery: A Retrospective Review.

Garoosi K, Mundra L, Jabbari K, Winocour J, Iorio M, Mathes D Aesthet Surg J Open Forum. 2023; 5:ojad080.

PMID: 37711766 PMC: 10499002. DOI: 10.1093/asjof/ojad080.

Medical Imaging of Inflammations and Infections of Breast Implants.

Giovannini E, Travascio L, Follacchio G, Bauckneht M, Criscuoli B, De Cataldo C Diagnostics (Basel). 2023; 13(10).

PMID: 37238291 PMC: 10217528. DOI: 10.3390/diagnostics13101807.

Use of Antibiotic-impregnated Polymethylmethacrylate (PMMA) Plates for Prevention of Periprosthetic Infection in Breast Reconstruction.

Johnstone T, Lipman K, Makarewicz N, Shah J, Turner E, Posternak V Plast Reconstr Surg Glob Open. 2023; 11(1):e4764.

PMID: 36776590 PMC: 9911200. DOI: 10.1097/GOX.0000000000004764.

Is Iatrogenic Implant Contamination Preventable Using a 16-Step No-Touch Protocol?.

Singh D, Zhang R, Hori K, Parsa F Eplasty. 2022; 22:e38.

PMID: 36160667 PMC: 9490878.

References

Khavanin N, Gutowski K, Hume K, Simmons C, Mlodinow A, Weiss M . The use of patient registries in breast surgery: a comparison of the tracking operations and outcomes for plastic surgeons and national surgical quality improvement program data sets. Ann Plast Surg. 2015; 74(2):157-62. DOI: 10.1097/SAP.0000000000000383. View

Fischer J, Nelson J, Au A, Tuggle 3rd C, Serletti J, Wu L . Complications and morbidity following breast reconstruction--a review of 16,063 cases from the 2005-2010 NSQIP datasets. J Plast Surg Hand Surg. 2013; 48(2):104-14. DOI: 10.3109/2000656X.2013.819003. View

Momoh A, Ahmed R, Kelley B, Aliu O, Kidwell K, Kozlow J . A systematic review of complications of implant-based breast reconstruction with prereconstruction and postreconstruction radiotherapy. Ann Surg Oncol. 2013; 21(1):118-24. PMC: 4153348. DOI: 10.1245/s10434-013-3284-z. View

Arciola C, Campoccia D, Speziale P, Montanaro L, Costerton J . Biofilm formation in Staphylococcus implant infections. A review of molecular mechanisms and implications for biofilm-resistant materials. Biomaterials. 2012; 33(26):5967-82. DOI: 10.1016/j.biomaterials.2012.05.031. View

Nahabedian M, Tsangaris T, Momen B, Manson P . Infectious complications following breast reconstruction with expanders and implants. Plast Reconstr Surg. 2003; 112(2):467-76. DOI: 10.1097/01.PRS.0000070727.02992.54. View

Fischer J, Nelson J, Serletti J, Wu L . Peri-operative risk factors associated with early tissue expander (TE) loss following immediate breast reconstruction (IBR): a review of 9305 patients from the 2005-2010 ACS-NSQIP datasets. J Plast Reconstr Aesthet Surg. 2013; 66(11):1504-12. DOI: 10.1016/j.bjps.2013.06.030. View

Gart M, Smetona J, Hanwright P, Fine N, Bethke K, Khan S . Autologous options for postmastectomy breast reconstruction: a comparison of outcomes based on the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg. 2012; 216(2):229-38. DOI: 10.1016/j.jamcollsurg.2012.11.003. View

Disa J, Cohen S, Cordeiro P, Hidalgo D . The premature removal of tissue expanders in breast reconstruction. Plast Reconstr Surg. 1999; 104(6):1662-5. DOI: 10.1097/00006534-199911000-00008. View

Shaikh-Naidu N, Preminger B, Rogers K, Messina P, Gayle L . Determinants of aesthetic satisfaction following TRAM and implant breast reconstruction. Ann Plast Surg. 2004; 52(5):465-70. DOI: 10.1097/01.sap.0000123901.06133.b7. View

10.

Saha D, Davila A, Ver Halen J, Jain U, Hansen N, Bethke K . Post-mastectomy reconstruction: a risk-stratified comparative analysis of outcomes. Breast. 2013; 22(6):1072-80. DOI: 10.1016/j.breast.2013.09.010. View

11.

Washer L, Gutowski K . Breast implant infections. Infect Dis Clin North Am. 2012; 26(1):111-25. DOI: 10.1016/j.idc.2011.09.003. View

12.

Luce E, Pierce C . Lack of Validity of the American College of Surgeons National Surgical Quality Improvement Program Database for Alloplastic Immediate Postmastectomy Reconstruction. Plast Reconstr Surg. 2015; 136(3):296e-300e. DOI: 10.1097/PRS.0000000000001515. View

13.

Olsen M, Lefta M, Dietz J, Brandt K, Aft R, Matthews R . Risk factors for surgical site infection after major breast operation. J Am Coll Surg. 2008; 207(3):326-35. PMC: 3618680. DOI: 10.1016/j.jamcollsurg.2008.04.021. View

14.

Reish R, Damjanovic B, Austen Jr W, Winograd J, Liao E, Cetrulo C . Infection following implant-based reconstruction in 1952 consecutive breast reconstructions: salvage rates and predictors of success. Plast Reconstr Surg. 2013; 131(6):1223-1230. DOI: 10.1097/PRS.0b013e31828bd377. View

15.

Argenta L . Reconstruction of the breast by tissue expansion. Clin Plast Surg. 1984; 11(2):257-64. View

16.

Wink J, Fischer J, Nelson J, Serletti J, Wu L . Direct-to-implant breast reconstruction: an analysis of 1612 cases from the ACS-NSQIP surgical outcomes database. J Plast Surg Hand Surg. 2014; 48(6):375-81. DOI: 10.3109/2000656X.2014.899240. View

17.

Wolcott R, Costerton J, Raoult D, Cutler S . The polymicrobial nature of biofilm infection. Clin Microbiol Infect. 2012; 19(2):107-12. DOI: 10.1111/j.1469-0691.2012.04001.x. View

18.

Spear S, Rottman S, Glicksman C, Brown M, Al-Attar A . Late seromas after breast implants: theory and practice. Plast Reconstr Surg. 2012; 130(2):423-435. DOI: 10.1097/PRS.0b013e3182589ea9. View

19.

Fischer J, Nelson J, Kovach S, Serletti J, Wu L, Kanchwala S . Impact of obesity on outcomes in breast reconstruction: analysis of 15,937 patients from the ACS-NSQIP datasets. J Am Coll Surg. 2013; 217(4):656-64. DOI: 10.1016/j.jamcollsurg.2013.03.031. View

20.

Chow I, Hanwright P, Hansen N, Leilabadi S, Kim J . Predictors of 30-day readmission after mastectomy: A multi-institutional analysis of 21,271 patients. Breast Dis. 2015; 35(4):221-31. DOI: 10.3233/BD-150412. View