Expander/Implant Removal After Breast Reconstruction: Analysis of Risk Factors and Timeline

Öztürk, Cemile Nurdan; Öztürk, Can; Soucise, Allison; Platek, Mary E.; Ahsan, Nabiha; Lohman, Robert; Moon, Wong; Djohan, Risal

doi:10.1007/s00266-017-1031-8

Cited by 30 publications

(35 citation statements)

References 43 publications

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“…Because population-based rates of vaccination vary nationally, we adjusted the model to account for population-level rates by age based on the CDC's population-level estimates (Supplemental Table 6). 32 To model the relationship between administration of doses of different vaccines at the hospital level, risk-adjusted vaccine administration rates were divided into quintiles on the basis of the percent difference from the risk-adjusted median rate of vaccine administration per 1000 hospitalizations by vaccine type. Given the number of hospitals and vaccines included in this study, a heat map was developed to display the risk-adjusted median rates of vaccine administration in quintiles.…”

Section: Discussionmentioning

confidence: 99%

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Vaccine Administration in Children’s Hospitals

et al. 2022

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OBJECTIVES: To examine inpatient vaccine delivery across a national sample of children’s hospitals. METHODS: We conducted a retrospective cohort study examining vaccine administration at 49 children’s hospitals in the Pediatric Health Information System database. Children <18 years old admitted between July 1, 2017, and June 30, 2019, and age eligible for vaccinations were included. We determined the proportion of hospitalizations with ≥1 dose of any vaccine type administered overall and by hospital, the type of vaccines administered, and the demographic characteristics of children who received vaccines. We calculated adjusted hospital-level rates for each vaccine type by hospital. We used logistic and linear regression models to examine characteristics associated with vaccine administration. RESULTS: There were 1 185 667 children and 1 536 340 hospitalizations included. The mean age was 5.5 years; 18% were non-Hispanic Black, and 55% had public insurance. There were ≥1 vaccine doses administered in 12.9% (95% confidence interval: 12.8–12.9) of hospitalizations, ranging from 1% to 45% across hospitals. The most common vaccines administered were hepatitis B and influenza. Vaccine doses other than the hepatitis B birth dose and influenza were administered in 1.9% of hospitalizations. Children had higher odds of receiving a vaccine dose other than the hepatitis B birth dose or influenza if they were <2 months old, had public insurance, were non-Hispanic Black race, were medically complex, or had a length of stay ≥3 days. CONCLUSIONS: In this national study, few hospitalizations involved vaccine administration with substantial variability across US children's hospitals. Efforts to standardize inpatient vaccine administration may represent an opportunity to increase childhood vaccine coverage.

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Section: Discussionmentioning

confidence: 99%

“…31 Age was examined as a continuous variable and categorized on the basis of age categories used by the CDC to estimate population-level vaccine coverage (0-18 months, 19-35 months, 3-6 years, 7-12 years, and $13 years). 32…”

Section: Patient Characteristicsmentioning

confidence: 99%

Vaccine Administration in Children’s Hospitals

et al. 2022

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“…Taking all these variables into account, we find it difficult to analyse the correlation between the specific type of bacteria and severe complications. However, according to other publications, well-established risk factors favouring development of infection include higher body mass index, old age (> 55 years), neoadjuvant chemotherapy, axillary lymph node dissection, hypertension, active smoking, or wound healing complications [ 10 , 17 – 18 ]. Patients with these factors should be carefully monitored and should undergo individualized antibiotic therapy.…”

Section: Discussionmentioning

confidence: 99%

Microbiology of breast tissue expanders

Molska¹,

Wichtowski²,

Murawa³

2021

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Introduction Infection is one of the most common complications of breast reconstruction. The presence of bacterial biofilm on the implant surface does not always manifest itself clinically as an infection. Still little is known about the factors that trigger the transition from a normal to a pathological state. The aim of study: To examine a specific profile of microorganisms associated with a tissue expander, and to ascertain whether the collection of intraoperative bacteriological swabs constitutes a significant predictive factor. Material and methods: A 2-centre review of outcomes of breast cancer patients who underwent immediate 2-stage expander-implant breast reconstruction between June 2020 and September 2021 was conducted. During this period, 68 replacements of expanders with implants from 56 women were performed. A bacteriological swab was taken from each expander compartment, and microbiological culture was performed. Patients’ characteristics were taken into consideration. Results Tissue expanders were implanted from 2 to 26 months. Seven patients had an emergency expander removed due to infection or damage to the device. Out of all 56 patients evaluated, 47 had a negative and 9 had a positive culture, 1 in both breasts. The results did not correlate closely with the clinical status. Conclusions Bacteria colonize both clinically normal and infected expanders. It is difficult to determine the specific flora associated with the pocket after expander-based reconstruction, and taking a bacteriological swab each time as a standard does not influence the success of treatment.

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“…24 Implantbased reconstruction is somewhat less intense, but may involve several more outpatient visits and implant-related surgeries, and is prone to unique complications such as capsular contracture and implant extrusion. [26][27][28] Although postoperative complications of the breast have been well documented for flap and implant-based reconstruction, few studies have focused on upper extremity complications. To the authors' knowledge, this is the first study to compare these two types of reconstruction with a focus on upper extremity function.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Upper Extremity Function in Implant and Autologous Breast Reconstruction

Alba

Schultz

Qin

et al. 2019

J reconstr Microsurg

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Background After mastectomy and breast reconstruction, many patients experience upper extremity complications, such as pain, restriction in motion, and lymphedema. Despite an aesthetically satisfactory outcome, these occurrences can diminish a patient's postoperative quality of life. Several studies have investigated the causes and incidence of these complications. However, there is currently a paucity of data comparing postoperative upper extremity function according to reconstruction technique. Methods A review was performed of patients enrolled in a physical therapy (PT) program after mastectomy and immediate breast reconstruction. PT initial encounter evaluations were used to gather data on patients' postoperative upper extremity function. Hospital records were used to gather surgical and demographic data. For each patient, data were collected for each upper extremity that was ipsilateral to a reconstructed breast. Data were then compared between patients who underwent implant-based versus autologous deep inferior epigastric perforator flap reconstruction. Results A total of 72 patients were identified, including 39 autologous and 33 implant-based reconstruction cases. Proportions of patients who underwent sentinel lymph node biopsies and axillary lymph node dissections were similar between the two groups. The autologous-based reconstruction patients had significantly higher arm pain at rest (p = 0.004) and with activity (p = 0.031) compared with implant patients. Shoulder range of motion and manual muscle test results were similar between groups, with the exception of elbow flexion, which was weaker in implant patients (p = 0.030). Implant patients were also more likely to report “severe difficulty” or “inability” to perform activities of daily living (p = 0.022). Edema/swelling, axillary cording, and lymphedema girth measurements were similar between the two groups. Conclusion Different techniques of breast reconstruction can result in different postoperative upper extremity complications. These data show specific areas where postoperative care and PT can be customized according to reconstruction type. Investigation is currently underway to determine the effect of PT on upper extremity function in these patients.

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Expander/Implant Removal After Breast Reconstruction: Analysis of Risk Factors and Timeline

Abstract: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Cited by 30 publications

References 43 publications

Vaccine Administration in Children’s Hospitals

Vaccine Administration in Children’s Hospitals

Microbiology of breast tissue expanders

Postoperative Upper Extremity Function in Implant and Autologous Breast Reconstruction

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