Obesity-related Risk Factors in Implant-based Breast Reconstruction Using AlloDerm

Yuen, James C.; Coleman, Cathryn A.; Erickson, Stephen W.

doi:10.1097/gox.0000000000001231

Cited by 17 publications

(10 citation statements)

References 19 publications

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“…In contrast, higher BMI and active tobacco use were found to be associated with a greater risk of infection and reconstructive failure. This is not surprising in light of previous reports demonstrating the unfavorable impact of these comorbidities on postoperative outcomes following implant‐based breast reconstruction 27,28 . Additionally, adjuvant chemotherapy was noted to increase the risk of infection in this study, validating the findings of Peled et al 29 …”

Section: Discussionsupporting

confidence: 91%

Preoperative β‐lactam antibiotic prophylaxis is superior to bacteriostatic alternatives in immediate expander‐based breast reconstruction

Miller

Remington

Nguyen

et al. 2021

Journal of Surgical Oncology

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Background Staged implant‐based breast reconstruction is the most common reconstructive modality following mastectomy. Postoperative implant infections can have a significant impact on adjuvant oncologic care and reconstructive outcome. Here, we investigate the impact of β‐lactam antibiotics (i.e., bactericidal) compared to alternative antibiotic agents on postoperative outcomes for implant‐based breast reconstruction. Methods A retrospective analysis of patients who underwent immediate sub‐pectoral tissue expander placement with an inferior acellular dermal matrix (ADM) sling at a single institution between May 2008 and July 2018 was performed. Patient demographics, comorbidities, and complication rates were retrieved. The impact of antibiotic regimen on postoperative outcomes, including infection rate and reconstructive failure, was investigated. Results A total of 320 patients with a mean age and BMI of 48.2 years and 25.0 kg/m2, respectively, who underwent 542 immediate breast reconstructions were included in the study. The use of a β‐lactam antibiotic was protective against postoperative infection (odds ratio [OR] = 0.467, p = .046), infection requiring operative management (OR = 0.313, p = .022), and reconstructive failure (OR = 0.365, p = .028). Extended, that is, post‐discharge, prophylaxis was not associated with any clinical benefit. Conclusion The use of β‐lactam antibiotics for pre‐/peri‐operative prophylaxis is superior to alternative antibiotics with a bacteriostatic mechanism of action regarding rates of postoperative infection and reconstructive failure following immediate tissue expander‐based breast reconstruction. Extended, that is, post‐discharge, prophylaxis does not appear to be indicated, regardless of the antibiotic chosen.

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Section: Discussionsupporting

confidence: 91%

Preoperative β‐lactam antibiotic prophylaxis is superior to bacteriostatic alternatives in immediate expander‐based breast reconstruction

Miller

Remington

Nguyen

et al. 2021

Journal of Surgical Oncology

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“…In addition, this particular population poses a challenge due to longer operative time and technical difficulties [74]. Our findings comply with previous studies on the association between obesity and increased risk of postoperative complications, including seroma, infection and reconstructive failure [32,74,75,76,77]. In addition, our analysis showed that the odds of complications increased 8.1% for each unit increase in a patient’s BMI.…”

Section: Discussionsupporting

confidence: 91%

Two-Staged Implant-Based Breast Reconstruction: A Long-Term Outcome Study in a Young Population

et al. 2019

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Background and objectives: Differences in patient anatomy and physiology exist between young and older patients undergoing breast reconstruction after mastectomy. Breast cancer has been described as being more aggressive, more likely to receive radiation, contralateral mastectomy, as well as bilateral reconstruction in young patients. Our purpose is to report long-term experience on two-staged implant-based breast reconstruction (IBR) in young females, with complication sub-analysis based on obesity and adjuvant radiation. Materials and Methods: Retrospective chart review of all consecutive young patients who underwent two-staged IBR at our institution, between 2000 and 2016, was performed. Patients between 15 and 40 years old with least 1-year follow-up were included. Univariate logistic regression models and receiver operating characteristic (ROC) curves were created. Results: Overall 594 breasts met our inclusion criteria. The mean age was 34 years, and the median follow-up was 29.6 months. Final IBR was achieved in 98% of breasts. Overall, 12% of breasts had complications, leading to explantations of 5% of the devices. Adjuvant radiation was followed by higher rates of total device explantations (p = 0.003), while obese patients had higher rates of total complications (p < 0.001). For each point increase in BMI, the odds of developing complications increased 8.1% (p < 0.001); the cutoff BMI to predict higher complications was 24.81 kg/m2. Conclusions: This population demonstrates high successful IBR completion and low explantation rates. These data suggest that obese women and those with planned adjuvant radiation deserve special counseling about their higher risk of complications.

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“…Patient factors are well understood and are important for patient counseling before surgery. 34,35 One of the covariates that has previously been discussed in other studies, diabetes, showed to be a significant factor in our univariate analysis in the rates of complication to occur, specifically breast wounds. Diabetes is noted to have a lack of association in causing complications from previous studies, which is believed to have minimal contribution to flap perfusion.…”

Section: Logistic Regression Analysismentioning

confidence: 74%

A Propensity Score–Matched Comparison of Perioperative Outcomes in Prepectoral Smooth Versus Textured Tissue Expander Breast Reconstruction

et al. 2023

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Introduction Textured tissue expanders (TEs) had previously gained popularity due to minimizing expander migration, rotation, and capsule migration. Recent studies, though, have revealed increased risk of anaplastic large-cell lymphoma associated with certain macrotextured implants, prompting surgeons at our institution to switch to smooth TEs; evaluation is thus required for specific viability and similarity of outcomes of smooth TEs. Our study aims to evaluate perioperative complications in prepectoral placement of smooth versus textured TEs. Methods Our retrospective study evaluated perioperative outcomes of patients who underwent bilateral prepectoral TE placement, with either smooth or textured TE, at an academic institution between 2017 and 2021 performed by 2 reconstructive surgeons. The perioperative period was defined as the interval between expander placement until conversion to flap/implant or removal of TE due to complications. Our primary outcomes included hematoma, seroma, wounds, infection, unspecified redness, total number of complications, and returns to operating room secondary to complications. Secondary outcomes included time to drain removal, total number of expansions, hospital length of stay, length of time until the next breast reconstruction procedure, next breast reconstruction procedure, and number of expansions. Results Two hundred twenty-two patients were evaluated in our study (141 textured, 81 smooth). After propensity matching (71 textured, 71 smooth), our univariate logistic regression showed no significant difference in perioperative complications between smooth and textured expanders (17.1% vs 21.1%; P = 0.396) or complications that required a return to the operating room (10.0% vs 9.2%; P = 0.809). No significant differences were noted for hematoma, seroma, infections, unspecified redness, or wounds between both groups. A significant difference was noted in days to drain out (18.57 ± 8.17 vs 20.13 ± 0.07, P = 0.001) and type of the next breast reconstruction procedure (P < 0.001). Our multivariate regression showed that breast surgeon, hypertension, smoking status, and mastectomy weight were significant for increased risk for complications. Conclusion Our study demonstrates similar rates and effectiveness of smooth versus textured TE when used for prepectoral placement, making smooth TEs a safe and valuable alternative for breast reconstruction because of their decreased risk of anaplastic large-cell lymphoma compared with textured TEs.

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Obesity-related Risk Factors in Implant-based Breast Reconstruction Using AlloDerm

Cited by 17 publications

References 19 publications

Preoperative β‐lactam antibiotic prophylaxis is superior to bacteriostatic alternatives in immediate expander‐based breast reconstruction

Preoperative β‐lactam antibiotic prophylaxis is superior to bacteriostatic alternatives in immediate expander‐based breast reconstruction

Two-Staged Implant-Based Breast Reconstruction: A Long-Term Outcome Study in a Young Population

A Propensity Score–Matched Comparison of Perioperative Outcomes in Prepectoral Smooth Versus Textured Tissue Expander Breast Reconstruction

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