Protocol for Prevention and Monitoring of Surgical Site Infections in Implant-Based Breast Reconstruction: Preliminary Results

Abstract

Surgical site infection in implant-based breast reconstruction is a complication with variable incidence reported in the literature. Due to potential loss of implant and reconstruction, it can have a strong psychological impact on patients. Background and objectives: This study aimed primarily at analyzing the current status of the surgical site infection (SSI), (type, time of onset, clinical presentation, pathogens and management) in patients who underwent implant-based breast reconstruction at our Breast Unit. Secondarily, we wanted to establish whether introduction of a new, updated evidence-based protocol for infection prevention can reduce SSI in implant-based breast reconstruction. Materials and Methods: A single-center retrospective study was performed primarily to evaluate the incidence and features of SSI after implant-based breast reconstruction from 2007 to 2020. In June 2020, a protocol for prevention of SSI in implant-based breast reconstruction was introduced in clinical practice. Secondarily, a data analysis of all patients who underwent implant-based breast reconstruction in compliance with this protocol was performed after preliminarily assessing its efficacy. Results: 756 women were evaluated after mastectomy and implant-based breast reconstruction for breast cancer. A total of 26 surgical site infections were detected. The annual incidence of SSI decreased over time (range 0–11.76%). Data relating to infections’ features, involved pathogens and implemented treatments were obtained. Since the introduction of the protocol, 22 patients have been evaluated, for a total of 29 implants. No early infections occurred. Conclusions: Surgical site infection rates at our Breast Unit are comparable to those reported in the literature. The SSI rates have shown a decreasing trend over the years. No SSI has occurred since the introduction of the prevention protocol for surgical site infection in June 2020.

The Impact of Nasal Staphylococcus aureus Carriage on Surgical-Site Infections after Immediate Breast Reconstruction: Risk Factors and Biofilm Formation Potential

“…Data in the literature regarding SSI prevention demonstrates a comprehensive approach to this problem, which covers 3 stages: preoperative planning, perioperative procedures, and postoperative management [ 25 – 27 ]. Factors affecting infection after implant insertion are multifaceted and have been extensively analyzed [ 28 , 29 ].…”

Fat grafting in autologous breast reconstruction: applications, outcomes, safety, and complications

“…One approach to achieve larger volumes is a more aggressive extended LD flap technique which involves harvesting the subcutaneous tissue with the skin paddle, though this carries a higher risk of seroma, contour deformities, and lumbar hernia and is restricted to patients with higher BMI [50][51][52][53][54] . Therefore, LD flaps often require augmentation with an implant to achieve satisfactory aesthetic outcomes [55,56] . Despite its widespread use, the risk associated with implant-based reconstruction after LD flap is relatively high, including capsular contracture, implant displacement and rupture, infection, and the possibility of repeating the procedure to exchange the implant after its expected end-of lifetime [56,57] .…”

“…Therefore, LD flaps often require augmentation with an implant to achieve satisfactory aesthetic outcomes [55,56] . Despite its widespread use, the risk associated with implant-based reconstruction after LD flap is relatively high, including capsular contracture, implant displacement and rupture, infection, and the possibility of repeating the procedure to exchange the implant after its expected end-of lifetime [56,57] .…”

“…Because of the high vascularity of LD flaps [58] , they are well suited for adjunct fat grafting to improve the resulting appearance and symmetry [9,49,59,60] . Volumes reported in several studies ranged between 90.5-425 mL [51,56,61,62] . The timing of fat grafting with regard to flap procedures does not appear to affect flap survival, as Zhu et al showed that all flaps survived regardless of the timing of grafting with no fat-grafting-related complications except for one patient that had undergone radiotherapy and needed additional fat grafting [51,63] .…”

“…Candidates for fat grafting with breast reconstruction are selected depending on the patient's acceptance of possible multiple surgeries, the availability of satisfactory donor sites, and the patient's physical and psychological health condition [48] . It is not favorable if the patient is a smoker or belongs to a high-risk group, including diabetic, obese, and of advanced age [56,69] . Throughout the preoperative assessment, gauging the patient's mindset and expectations of fat grafting is crucial to outcome success and the patient's satisfaction.…”