Postoperative Complications in Prosthesis-Based Breast Reconstruction Using Acellular Dermal Matrix

Liu, Allen S.; Kao, Huang‐Kai; Reish, Richard G.; Hergrueter, Charles A.; May, James W.; Guo, Lifei

doi:10.1097/prs.0b013e31820cf233

Cited by 198 publications

(136 citation statements)

References 19 publications

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“…Several features of implants, such as texture or polyurethane coating [15], do not seem to be able to modify the infection rate. Instead, implant coating with acellular dermal matrix increases the risk of infection, as confirmed by Liu et al [16] in a case report of 470 patients that noted, after immediate reconstruction, a 4.2% rate of implant removal due to infection for implants coated with acellular dermal matrix, compared to 2.4% for non-coated implants. With regard to contamination of saline implants, although the shell is not permeable to bacteria [17], bacteria can enter into the lumen through the implant valve [18].…”

Section: Risk Factorsmentioning

confidence: 65%

Infections in breast implants: a review with a focus on developing countries

Rubino

Brongo

Pagliara

et al. 2014

J Infect Dev Ctries

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The risk of surgical site infection is always present in surgery; the use of prosthetic materials is linked to an increased possibility of infection. Breast augmentation and breast reconstruction with implants are gaining popularity in developing countries. Implant infection is the main complication related to breast aesthetic and reconstructive surgery. In the present paper, we reviewed the current microbiological knowledge about implant infections, with particular attention to risk factors, diagnosis, clinical management, and antibiotic prophylaxis, focusing on reports from developing countries. After breast aesthetic surgery, up to 2.9% of patients develop a surgical site infection, with an incidence of 1.7% for acute infections and 0.8% for late infections. The rate of surgical site infection after post-mastectomy breast reconstruction is usually higher, ranging from 1% to 53%. The clinical features are not constant, and bacterial culture with antibiogram is the gold standard for diagnosis and for identification of antibiotic resistance. While waiting for culture results, empiric therapy with vancomycin and extendedspectrum penicillins or cephalosporins is recommended. Some patients require removal of the infected prosthesis. The main methods to bring down the risk of infection are strict asepsis protocol, preoperative antibiotic prophylaxis, and irrigation of the surgical pocket and implant with an antibiotic solution.Key words: breast implant infections; acute infections; late infections; fungal infections; rare infections. EpidemiologyImplant infection is the main complication related to breast aesthetic and reconstructive surgery [1]. After breast aesthetic augmentation, up to 2.9% of women are affected by infection [2], with an incidence of 1.7% for acute infections versus an incidence of 0.8% for late infections, as confirmed by retrospective cohort studies with long-term follow-ups [1]. In developing countries, this problem is even more prevalent; surgery has a 50% rate of possible complications, of which infection is the main complication [3]. The rate of surgical site infection after post-mastectomy breast reconstruction is usually higher, ranging from 1% to 53% [4,5]. In breast reconstruction, a higher rate of infection was reported with expander implants compared to reconstruction with autologous tissue such as latissimus dorsi flaps [6]. The highest rates were found in women undergoing immediate reconstruction [4]. The reported number of infections after mammary augmentation and reconstruction is lower than the real incidence, because of the lack of a surveillance network of patients based on long-time follow-ups. The economic commitment for management of implant infections is significant. Kirkland et al. [7] reported an increase of hospital permanence for surgical site infection of 6.5 days, with related health care costs. In the United States, health care costs for surgical site infection after breast surgery were estimated to be about $4,091 [7], or $574 in the outpatient setting [9]...

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Section: Risk Factorsmentioning

confidence: 65%

Infections in breast implants: a review with a focus on developing countries

Rubino

Brongo

Pagliara

et al. 2014

J Infect Dev Ctries

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“…However, several studies have also shown increased rates of seroma formation in patients who have undergone AlloDerm-associated (LifeCell Corp., Branchburg, NJ) reconstructions [16,17,22,23], with an incidence ranging from 0 to 9 % in one particular systematic review [1]. Poor contact between the ADM and overlying tissues secondary to irregularity at the soft tissue interface and intentional under inflation of the tissue expander have been cited as reasons for these increased seroma rates [8,22].…”

Section: Discussionmentioning

confidence: 99%

Acellular dermal matrix fenestrations and their effect on breast shape

et al. 2015

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Background Acellular dermal matrices (ADMs) are increasingly being utilized in primary and secondary breast reconstruction as they confer several advantages, including soft tissue enhancement at the inferolateral pole of the breast. The senior authors have added fenestrations to ADMs to allow for more rapid expansion and improved breast aesthetics. The purpose of this study is to describe the benefits of ADM fenestration using a mathematical formula as a proof of concept for the effects of these modifications on breast shape. Methods The aggregate effect of symmetrically arranged fenestrations on the ADM's mechanical properties is explained by a uniform reduction in the effective Young's modulus of the graft in a direction perpendicular to the chest wall in the area of graft fenestration. Asymmetric reduction of the Young's modulus is achieved by concentration of the fenestrations at either the cephalic or caudal ends of the ADM. Results The relaxed Young's modulus facilitates an increased deflection of the ADM from its resting, unaltered state under the weight of the implant or tissue expander and is modeled using a one-dimensional boundary equation. The reduced inferior pole tension allows for enhanced expansion under the weight of the implant or tissue expander. The effects of asymmetrically arranged fenestrations are similarly modeled and appear to afford the surgeon greater precision in controlling inferior pole characteristics.Conclusions Acellular dermal matrix fenestration improves aesthetic outcome by facilitating greater inferior pole expansion. Mathematical models are provided to describe the modifications and elucidate the mechanism behind their effect on breast shape. Level of Evidence: Not ratable

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“…Continued tobacco use after a cancer diagnosis has been associated with various detrimental clinical outcomes such as shorter survival (Videtic et al, 2003;Fox et al, 2004;Sardari Nia et al, 2005;Zhou et al, 2006;Nguyenet al, 2010;Parsonset al, 2010;Kenfield, et al, 2011); increased risk of tumor recurrence or development of secondary malignancies (Do et al, 2003;Kawaguchi et al, 2006;Garces et al, 2007;Kaufman et al, 2008;Li et al, 2009;Joshu et al, 2011); poorer response to treatment and an increased risk of treatment toxicities (Monson et al, 1998;Dresler, 2003;O'Sullivan et al, 2003;van der Bol et al, 2007;de Jong et al, 2008;Waller et al, 2011;Petros et al, 2012); an increased risk of surgical complications (Moller et al, 2002;Barrera et al, 2005;Selber et al, 2006;Liu et al, 2011); and inferior bone marrow transplantation outcomes (Marks et al, 2009;Ehlers et al, 2011 ;Tran et al, 2011). Conversely, smoking cessation post-cancer diagnosis has been associated with better pain control and an improved quality of life (Garces et al, 2004;Baser et al, 2006;Daniel et al, 2009;Ditre et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Smoking Cessation Treatment and Outcomes in Medium to Heavy Cigarette Smokers being Treated for Cancer in Jordan

Hawari¹,

Obeidat²,

Ayub³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Background: Studies evaluating smoking cessation treatment outcomes in cancer patients are scarce, despite smoking cessation importance in cancer care. We sought to add to the literature by evaluating smoking cessation in a challenging group of cancer patients (medium-to-heavy smokers) visiting an out-patient smoking cessation clinic (SCC) in a cancer center in Amman, Jordan. Materials and Methods: Patients smoking >9 cigarettes per day (CPD) and referred to the SCC between June 2009 and May 2012 were studied. Clinic records were reviewed to measure demographic and baseline clinical characteristics, and longitudinal (3-, 6-and 12-month) followup by phone/clinic visit was conducted. At each follow-up, patients were asked if they experienced medication side-effects, if they had returned to smoking, and reasons for failing to abstain. Descriptive and multivariable logistic regression analyses were performed. Results: A total of 201 smokers were included in the analysis. The 3-month abstinence was 23.4% and significantly associated with older age, being married, and presenting with lower (≤10ppm) baseline carbon monoxide (CO) levels. On a multivariable level, lower CO levels, a higher income (relative to the lowest income group), being older, and reporting severe dependence (relative to dependence reported as 'somewhat' or 'not') were significant predictors of higher odds of abstinence at three months. Reasons for failing to quit included not being able to handle withdrawal and seeing no value in quitting. Longterm ARs did not reach 7%. Conclusions: In a sample of Jordanian smokers (>9CPD) with cancer and receiving smoking cessation treatment, ARs were low and further declined with time. Results underscore the need for more aggressive patient management and rigorous follow-up during and after smoking cessation treatment, particularly when this takes place in challenging settings. Observed reasons for failure to abstain should be used to tailor counseling practices.

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Postoperative Complications in Prosthesis-Based Breast Reconstruction Using Acellular Dermal Matrix

Cited by 198 publications

References 19 publications

Infections in breast implants: a review with a focus on developing countries

Infections in breast implants: a review with a focus on developing countries

Acellular dermal matrix fenestrations and their effect on breast shape

Smoking Cessation Treatment and Outcomes in Medium to Heavy Cigarette Smokers being Treated for Cancer in Jordan

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