Byline: Ashley. Boustany, Shady. Elmaraghi, Nneamaka. Agochukwu, Benjamin. Cloyd, Adam. Dugan, Brian. Rinker
Background: Infection following augmentation and prosthetic-based breast reconstruction can cause significant physical and psychological distress for patients. It may delay adjuvant therapies and compromise aesthetic outcomes. The aim of this study is to identify modifiable risk factors for infection and identify common bacterial isolates to achieve optimal outcomes for patients. Methods: A retrospective cohort study was performed for patients undergoing implant-based breast reconstruction over a 2-year period. In each case, we documented demographics, co-morbidities, complications and antibiotic use. We reviewed treatments, infectious species cultured where applicable and all outcomes. Results: A total of 292 patients met the inclusion criteria. Fifty-five patients (19%) developed an infection. Univariate analysis showed a significantly increased infection rate with longer operative times (P = 0.001) and use of tissue expanders (P = 0.001). Multiple logistic regression analysis confirmed drain use and elevated body mass index (BMI) as risk factors (odds ratio [OR] 2.427 and 1.061, respectively). After controlling for BMI, smoking status and radiation, we found an increased odd of infection with allograft use (OR 1.838) and a decreased odd with skin preparation using 2% chlorhexidine gluconate in 70% isopropyl (OR 0.554), though not statistically significant. Forty of 55 patients with infections had cultures, with 62.5% of isolates being Gram-positive species and 30% Gram-negative species. The median time to clinical infection was 25 days. Implant salvage with surgical interventions was achieved in 61.5% of patients. Conclusions: This study identified judicious use of drains and efficiency in the operating room as modifiable risk factors for infections following implant-based breast reconstruction. Prospective trials to analyse techniques for infection prevention are warranted. Implant salvage following infection is a possible end-point in the appropriate patient.
One in eight women will develop invasive breast cancer over the course of their lifetime. About 35-40% of those diagnosed annually will be treated with a total mastectomy, and more of these patients are pursuing breast reconstruction in recent years. In 2013, over 95,000 reconstructive breast procedures were performed, 75,000 of which were expander-implant-based reconstructions. Infections following augmentation and implant-based breast reconstruction cause significant physical and psychological distress for patients. It delays adjuvant therapies and leads to compromise of aesthetic outcomes. Breast implant infections also pose a significant financial burden on the health-care system. Olsen et al . found that infections after breast operations are associated with a cost over $4,000 per patient. Implant infection following breast reconstruction is not an uncommon event; rates cited in the literature range from 2.5% to 16.5%. Implant infection following breast augmentation is much less common with rates of 1%-2.5%.,,,,,,,
Identification and modification of risk factors for infection leads to better counselling for patients and undoubtedly improves outcomes. Previously described risk factors for the development of implant infections following reconstruction include: Elevated body mass index (BMI), use of drains, smoking, medical co-morbidities, the use of acellular dermal matrix (ADM), concurrent procedures, chemotherapy, radiation therapy and immediate reconstruction. However, there is much variability in the...