Beyond 30 Days: A Risk Calculator for Longer Term Outcomes of Prosthetic Breast Reconstruction

Blough, Jordan T.; Vu, Michael M.; Qiu, Cecil S.; Mlodinow, Alexei S.; Khavanin, Nima; Fine, Neil A.; Kim, John Y.S.

doi:10.1097/gox.0000000000002065

Cited by 17 publications

(9 citation statements)

References 56 publications

(56 reference statements)

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“…The existence of a significant risk of complications (especially infectious) related to radiotherapy was shown by Jagsi et al (2016) and among the most common adverse effects, they mention an increased risk of wound infection between 7 and 24 months after sur-gery, and consequently the requirement to remove the implant. Similar observations were also presented by other authors (Momoh et al 2014;Blough et al 2018). In our work, the median time to remove the implant after using radiotherapy was 3-4 months after surgery.…”

supporting

confidence: 92%

“…In our study, this allowed the detection of approximately 90% of infections. The necessity to monitor for complications after breast reconstruction during one year after surgery, instead of 30 days, has also been indicated by other researchers (Blough et al 2018), who used individualized tools to assess the risk of post-surgery complications within one year of breast reconstruction.…”

mentioning

confidence: 99%

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Significance of Infections in Implant Loss After Breast Reconstruction in the Course of Breast Cancer Treatment

Szymankiewicz¹,

Nowikiewicz

Biedka

2019

Polish Journal of Microbiology

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The aim of the study was to analyze the reasons for removing implants after breast reconstruction in the course of treatment of breast cancer. The study involved 428 patients, who underwent a total of 648 breast reconstruction procedures using artificial implants. 47 out of 648 cases (7.3%) were identified in which the implant had to be removed. Of the 47 cases, 57.4% had undergone deferred reconstruction, and 42.6% immediate reconstruction; 27.7% had undergone pre-operative chemotherapy and radiotherapy, 27.7% pre-operative chemotherapy, and 2.1% pre-operative radiotherapy; 6.4% were diabetic, 4.3% active smokers, and more than 50.0% had BMI greater than 25 kg/m2. In 83.0% of the analyzed cases, the reason for removal of the implant was infection, in 8.5% it was local recurrence of breast cancer, in 4.3% it was damage (leakage) of the implant, and in 2.1% it was post-operative pain. About 87.0% of infections appeared within one year of implantation; however, less than a half developed within 90 days of the reconstructive surgery, and up to 30 days only about 13.0% had appeared. Among the etiological agents of infections were: coagulase-negative Staphylococcus (31.3%), Staphylococcus aureus (18.7%), Enterococcus faecalis (9.4%), Enterobacter cloacae (18.8%), Pseudomonas aeruginosa (12.5%), Acinetobacter lwoffii (3.1%), and other Gram-negative fermenting rods accounted for 6.2%. Infections were the most common reason for removing the implant after breast reconstruction. and occurred most often as late infections (> 30 days after surgery). The time of observation for infectious complications should be at least 1 year.

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supporting

confidence: 92%

mentioning

confidence: 99%

Significance of Infections in Implant Loss After Breast Reconstruction in the Course of Breast Cancer Treatment

Szymankiewicz¹,

Nowikiewicz

Biedka

2019

Polish Journal of Microbiology

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“…The length of follow-up is an important factor associated with reported SSI rates because most cases of implant removal do not occur within the first 30 days but later during the postoperative period, sometimes as late as 1 year after surgery . Cohen et al reported the median time to implant removal to be 41 days.…”

Section: Discussionmentioning

confidence: 99%

“…43 The length of follow-up is an important factor associated with reported SSI rates because most cases of implant removal do not occur within the first 30 days but later during the postoperative period, sometimes as late as 1 year after surgery. 11,19,[44][45][46] Cohen et al 47 reported the median time to implant removal to be 41 days. In their study, with a 12-month follow-up, 30 of 38 patients (80%) who lost their implant because of SSI did so within the first 6 months following surgery.…”

Section: Jama Network Open | Surgerymentioning

confidence: 99%

Effectiveness of Single vs Multiple Doses of Prophylactic Intravenous Antibiotics in Implant-Based Breast Reconstruction

et al. 2022

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IMPORTANCE Multiple-dose antibiotic prophylaxis is widely used to prevent infection after implantbased breast reconstruction despite the lack of high-level evidence regarding its clinical benefit. OBJECTIVE To determine whether multiple-dose antibiotic prophylaxis is superior to single-dose antibiotic prophylaxis in preventing surgical site infection (SSI) after implant-based breast reconstruction. DESIGN, SETTING, AND PARTICIPANTS This prospective, multicenter, randomized clinical superiority trial was conducted at 7 hospitals (8 departments) in Sweden from April 25, 2013, to October 31, 2018. Eligible participants were women aged 18 years or older who were planned to undergo immediate or delayed implant-based breast reconstruction. Follow-up time was 12 months. Data analysis was performed from May to October 2021. INTERVENTIONS Multiple-dose intravenous antibiotic prophylaxis extending over 24 hoursfollowing surgery, compared with single-dose intravenous antibiotic. The first-choice drug was cloxacillin (2 g per dose). Clindamycin was used (600 mg per dose) for patients with penicillin allergy. MAIN OUTCOMES AND MEASURESThe primary outcome was SSI leading to surgical removal of the implant within 6 months after surgery. Secondary outcomes were the rate of SSIs necessitating readmission and administration of intravenous antibiotics, and clinically suspected SSIs not necessitating readmission but oral antibiotics. RESULTSA total of 711 women were assessed for eligibility, and 698 were randomized (345 to single-dose and 353 to multiple-dose antibiotics). The median (range) age was 47 (19-78) years for those in the multiple-dose group and 46 (25-76) years for those in the single-dose group. The median (range) body mass index was 23 (18-38) for the single-dose group and 23 (17-37) for the multipledose group. Within 6 months of follow-up, 30 patients (4.3%) had their implant removed because of SSI. Readmission for intravenous antibiotics because of SSI occurred in 47 patients (7.0%), and 190 women (27.7%) received oral antibiotics because of clinically suspected SSI. There was no significant difference between the randomization groups for the primary outcome implant removal (odds ratio [OR], 1.26; 95% CI, 0.69-2.65; P = .53), or for the secondary outcomes readmission for intravenous antibiotics (OR, 1.18; 95% CI, 0.65-2.15; P = .58) and prescription of oral antibiotics (OR, 0.72; 95% CI, 0.51-1.02; P = .07). Adverse events associated with antibiotic treatment were more common in the multiple-dose group than in the single-dose group (16.4% [58 patients] vs 10.7% [37 patients]; OR, 1.64; 95% CI, 1.05-2.55; P= .03).

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“…However, long-term complications that may be associated with mesh absorption like implant malposition or capsular contracture would not have been captured. 45 Our institution continues to collect data on a variety of techniques using this product for future analysis. Besides the foregoing discussion of intraoperative determination of prepectoral eligibility, we do not believe this study was subject to any specific selection bias, as the choice to use PDO mesh was presented to all patients eligible for immediate prosthetic breast reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Early Clinical Outcomes of Polydioxanone Mesh for Prepectoral Prosthetic Breast Reconstruction

Qiu

Seth

2022

Plastic and Reconstructive Surgery - Global Open

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Background: Many biologic matrices and synthetic meshes are available as adjuncts for prosthetic and autologous breast reconstructions to help control implant position and to reinforce abdominal flap donor sites. Absorbable synthetic meshes may have advantages over biologic matrices and permanent meshes, such as lower cost and better long-term biocompatibility. We present a prospective case series of patients undergoing two-stage, prepectoral breast reconstruction with polydioxanone (PDO) mesh. Methods: This prospective, consecutive single-surgeon series of patients who received PDO mesh during two-stage, prepectoral breast reconstruction involved incorporation of the PDO mesh at stage 1 as an anterior tarp over the tissue expander. A detailed description of surgical technique is provided herein. Surgical complications monitored included surgical site infection, wound dehiscence, mastectomy skin flap necrosis, hematoma or seroma requiring operative intervention, and reconstructive failure. Results: Seven patients with fourteen breast reconstructions were included in the study. All patients had unilateral cancer and underwent bilateral mastectomies with immediate reconstruction. The average age of patient was 50.0 (SD 7.4) and BMI was 29.3 (SD 2.7). Patients were followed for a median of 274 days, during which only one late infection (7.1%) occurred requiring expander removal. Conclusions: PDO mesh has an acceptable short-term complication rate in two-stage prepectoral prosthetic breast reconstruction. Future investigations should elucidate its comparative efficacy and safety against alternative products with respect to long-term outcomes.

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Beyond 30 Days: A Risk Calculator for Longer Term Outcomes of Prosthetic Breast Reconstruction

Abstract: Supplemental Digital Content is available in the text.

Cited by 17 publications

References 56 publications

Significance of Infections in Implant Loss After Breast Reconstruction in the Course of Breast Cancer Treatment

Significance of Infections in Implant Loss After Breast Reconstruction in the Course of Breast Cancer Treatment

Effectiveness of Single vs Multiple Doses of Prophylactic Intravenous Antibiotics in Implant-Based Breast Reconstruction

Early Clinical Outcomes of Polydioxanone Mesh for Prepectoral Prosthetic Breast Reconstruction

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