Infection Following Breast Reconstruction

Rw, Armstrong; Rl, Berkowitz; Bolding, Fern

doi:10.1097/00000637-198910000-00003

Cited by 80 publications

(20 citation statements)

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“…The rate of breast implant infection in the present work (6.7%) was similar to that observed in previous reports [1][2][3][4]. This confirms its occurrence at a higher incidence than after breast implant surgery in patients without cancer [1].…”

Section: Discussionsupporting

confidence: 92%

“…Although conclusions are limited by the size of the infected cohort, we observed that radiotherapy after surgery is associated with a risk of implant infection. This is in line with other recent reports [3]. Altogether, these observations indicate that radiotherapy may determine minimal residual cutaneous damage with possible barrier breaks and bacterial seeding.…”

supporting

confidence: 93%

“…Indeed, if had we used such a short observation period, we would have been prevented from identifying the more than one-half (56%) of the infections that occurred more than two months after surgery. Other studies do not mention the timing of prosthetic infection [1,3,5,8,11,12,15]. Thus, the first six months after surgery represent the period of highest risk of infection, during which patients may benefit from closer clinical monitoring.…”

Section: Discussionmentioning

confidence: 99%

“…The rate of infection after breast reconstruction ranges from 1.5% to 12% and is significantly higher when dermal matrix is used [1][2][3][4]. Some reports based on retrospective analyses of extended time-frames (as long as 20 years) found low infection rates (1.8%-3%), probably as a result of retrospective study bias [5].…”

mentioning

confidence: 99%

“…Several factors have been linked to a higher risk of infection, including chemotherapy, immediate or bilateral reconstruction [2], radiotherapy, and axillary node dissection [3]. Tissue scarring and skin atrophy following chemotherapy or radiotherapy affect postoperative tissue ischemia and delay wound healing, thus explaining their association with SSI in cancer patients with breast implants [6].…”

mentioning

confidence: 99%

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Breast Implant Infections after Surgical Reconstruction in Patients with Breast Cancer: Assessment of Risk Factors and Pathogens over Extended Post-Operative Observation

Franchelli

Vassallo

Porzio

et al. 2012

Surgical Infections

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Section: Discussionsupporting

confidence: 92%

supporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Breast Implant Infections after Surgical Reconstruction in Patients with Breast Cancer: Assessment of Risk Factors and Pathogens over Extended Post-Operative Observation

Franchelli

Vassallo

Porzio

et al. 2012

Surgical Infections

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Pharmacokinetics of Locally Applied Antibiotic Prophylaxis for Implant-Based Breast Reconstruction

Hemmingsen,

Bennedsen,

Kullab

et al. 2023

JAMA Netw Open

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ImportanceAntibiotic irrigation of breast implants is widely used internationally, but no clinical study has investigated the pharmacokinetics of antibiotic prophylaxis in the breast implant pocket.ObjectivesTo evaluate how long locally applied gentamicin, cefazolin, and vancomycin concentrations in the implant pocket remain above the minimum inhibitory concentration (MIC) for the most common bacterial infections and to measure systemic uptake.Design, Setting, and ParticipantsThis prospective cohort study was performed at the Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark, between October 25, 2021, and September 22, 2022, among 40 patients undergoing implant-based breast reconstruction who were part of the ongoing BREAST-AB trial (Prophylactic Treatment of Breast Implants With a Solution of Gentamicin, Vancomycin and Cefazolin Antibiotics for Women Undergoing Breast Reconstructive Surgery: a Randomized Controlled Trial). Patients were randomized to receive locally applied gentamicin, cefazolin, and vancomycin or placebo. Samples were obtained from the surgical breast drain and blood up to 10 days postoperatively.ExposuresThe breast implant and the implant pocket were irrigated with 160 μg/mL of gentamicin, 2000 μg/mL of cefazolin, and 2000 μg/mL of vancomycin in a 200-mL saline solution.Main Outcomes and MeasuresThe primary outcome was the duration of antibiotic concentrations above the MIC breakpoint for Staphylococcus aureus according to the Clinical and Laboratory Standards Institute: gentamicin, 4 μg/mL; cefazolin, 2 μg/mL; and vancomycin, 2 μg/mL. Secondary outcomes included the time above the MIC for Pseudomonas aeruginosa and other relevant bacteria, as well as systemic uptake.ResultsThe study included 40 patients (median age, 44.6 years [IQR, 38.3-51.4 years]; median body mass index, 23.9 [IQR, 21.7-25.9]) with a median number of 3 drain samples (range, 1-10 drain samples) and 2 blood samples (range, 0-6 blood samples). Vancomycin and cefazolin remained above the MIC for S aureus significantly longer than gentamicin (gentamicin, 0.9 days [95% CI, 0.5-1.2 days] for blood samples vs 6.9 days [95% CI, 2.9 to 10.9 days] for vancomycin [P = .02] vs 3.7 days [95% CI, 2.2-5.2 days] for cefazolin [P = .002]). The gentamicin level remained above the MIC for P aeruginosa for 1.3 days (95% CI, 1.0-1.5 days). Only cefazolin was detectable in blood samples, albeit in very low concentrations (median concentration, 0.04 μg/mL [range, 0.007-0.1 μg/mL]).Conclusions and RelevanceThis study suggests that patients treated with triple-antibiotic implant irrigation during breast reconstruction receive adequate prophylaxis for S aureus and other common implant-associated, gram-positive bacteria. However, the protection against P aeruginosa may be inadequate.

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Influence of complications following immediate breast reconstruction on breast cancer recurrence rates

Beecher

O’Leary

McLaughlin

et al. 2016

British Journal of Surgery

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Infection Following Breast Reconstruction

Cited by 80 publications

References 0 publications

Breast Implant Infections after Surgical Reconstruction in Patients with Breast Cancer: Assessment of Risk Factors and Pathogens over Extended Post-Operative Observation

Breast Implant Infections after Surgical Reconstruction in Patients with Breast Cancer: Assessment of Risk Factors and Pathogens over Extended Post-Operative Observation

Pharmacokinetics of Locally Applied Antibiotic Prophylaxis for Implant-Based Breast Reconstruction

Influence of complications following immediate breast reconstruction on breast cancer recurrence rates

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