Reducing Infection Rates in Implant-Based Breast Reconstruction

Dassoulas, Kasandra; Wang, Jessica; Thuman, Jenna; Ndem, Idorenyin; Schaeffer, Christine; Stovall, Madeline; Tilt, Alexandra; Lee, Andy Chao Hsuan; Lin, Kant Y.; Campbell, Christopher A.

doi:10.1097/sap.0000000000001407

Cited by 36 publications

(40 citation statements)

References 43 publications

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“…Despite these advances, infections, resulting in reconstructive failure, have a documented rate between 2.5% and 24%. 18 , 19 , 21 – 23 , 32 Khansa et al 20 and others 21 – 23 have published standardized best-practice protocols for preoperative, intraoperative, and postoperative measures to reduce infections. Despite following these protocols, we had a reconstructive failure rate secondary to infection of 10%.…”

Section: Discussionmentioning

confidence: 99%

“…We followed the protocol outlined by Khansa et al 20 and others 21 – 23 for patients undergoing TE reconstruction after mastectomy to minimize infectious complications. All reconstructions used any one of the 3 different thick acellular dermal matrices (ADMs): AlloDerm (reference 102320; LifeCell/Allergan, Bridgewater, N.J.), FlexHD (reference HP1620; MTF Biologics, Edison, N.J.), and Cortiva (reference DH 1620; RTI Surgical, Alachua, Fla.) motivated by cost and availability.…”

Section: Methodsmentioning

confidence: 99%

“…Khansa et al 20 published a standardized best-practices protocol to reduce infections after tissue expander (TE) reconstruction. Despite following this protocol and implementing recommendations from several other recent reports, 21 – 23 our reconstructive failure rate secondary to infection was over 10% in the HS. We felt that there were likely variables out of our control in the HS that might be contributing to our increased incidence of infections and that changing venue might reduce infectious complications.…”

Section: Introductionmentioning

confidence: 93%

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Mastectomy and Prepectoral Reconstruction in an Ambulatory Surgery Center Reduces Major Infectious Complication Rates

Schwartz

2020

Plastic and Reconstructive Surgery - Global Open

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Background: Mastectomy and implant-based reconstruction is typically performed in a hospital setting (HS) with overnight admission. The aim of this study was to evaluate postoperative complications and outcomes with same-day discharge from an ambulatory surgery center (ASC) compared with the same surgery performed in the HS. Methods: Patients who underwent mastectomy and immediate prepectoral tissue expander reconstruction were included in this retrospective study. Surgery was performed in an ASC with same-day discharge or the HS with overnight observation or same-day discharge. Patient demographics, operative details, outcomes, complications, and patient satisfaction were compared. Results: One hundred six women (183 breasts) underwent surgery in the HS, and 103 women (177 breasts) had their surgery in an ASC between August 2014 and September 2019. Demographics, comorbidities, and operative details were similar. Although there was no difference in the rates of most major complications, infectious complications requiring operative intervention were less frequent in the ASC [2.3% (n = 4) versus 11.5% (n = 21); P = 0.001]. Patient satisfaction, evaluated with a 5-point Likert scale, was higher in the ASC. Conclusions: Mastectomy and prepectoral reconstruction in an ASC is a safe alternative to the standard approach of performing this procedure in the HS. Although the rates of most surgical complications are similar between the HS and ASC, we have found a significantly reduced rate of major infectious complications requiring surgical intervention in the ASC which reduces overall cost and patient morbidity. Finally, patient satisfaction was higher in the ASC compared with the HS.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

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Mastectomy and Prepectoral Reconstruction in an Ambulatory Surgery Center Reduces Major Infectious Complication Rates

Schwartz

2020

Plastic and Reconstructive Surgery - Global Open

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“…This is consistent with the current literature. 2,18 -20 However, this is not a modifiable risk factor. Furthermore, the finding of larger expander/implant size as a risk factor for postop infection (OR: 1.41, CI: 1.05-1.90, P = .023) is also in agreement with the results of a cohort study by Selber et al 21…”

Section: Discussionmentioning

confidence: 98%

Antibiotic Prophylaxis in Alloplastic Breast Reconstruction: Regimens and Outcomes

et al. 2021

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Purpose: Surgical site infections (SSI) in prosthesis-based breast reconstruction can have a significant impact on patient outcome. Despite current CDC (Centers for Disease Control and Prevention) guidelines recommending 24 hours of postoperative antibiotics, various perioperative antimicrobial regimens are reported in the literature. Consensus on the optimal duration of antibiotics remains unclear. In this study, the aim is to compare the incidence of surgical site infections following different antibiotic durations in alloplastic breast reconstruction. Methods: In this retrospective cohort study, all consecutive patients who underwent expander/implant-based breast reconstruction between January 2009 and December 2014 at a tertiary centre were included. Data on patient demographics, risk factors, operative time, choice and timing of antibiotic used before surgery, and the duration of postoperative antibiotic use were collected. The primary outcome, SSI, is defined according to CDC criteria. Results: A total of 507 consecutive expander/implant-based cases were included. Minimum follow-up time was 1 year. The overall infection incidence was 14% (95% CI: 11%-17%), and the rate of subsequent explantation was 8%. Of the infected cases, 80% (45/56) received 1 week of postoperative antibiotic, while 20% (11/56) had a prolonged course of antibiotics (2-3 weeks; P = .003, odds ratio [OR] = 2.9; 95% CI: 1.4-5.8). Most infections were superficial (65%). Prior history of radiation treatment was identified as a risk factor for developing surgical site infection ( P = .02). Conclusion: Overall infection rate and risk factors for infections are in keeping with current literature. Prescribing one week of postoperative antibiotic was found to be associated with a higher incidence of SSI compared to a more prolonged antibiotic regimen.

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“…Other risk factors for infection includes radiation, obesity, smoking, large breast size, chemotherapy, prolonged drain duration, and advanced age, which are typically more frequent in breast reconstruction patients. 34 , 38 – 40 Free tissue transfer survival is dependent on maintaining arterial inflow and venous outflow through a patent arterial and venous anastomosis. Several articles have described complete flap survival despite injury to the vascular pedicle 41 – 43 ; however, these examples are from the head and neck reconstruction literature, where the size of free flaps are typically significantly smaller than abdominally based flaps.…”

Section: Discussionmentioning

confidence: 99%

Secondary Implant Augmentation in the Subpectoral Plane following Abdominal-based Perforator Flaps for Breast Reconstruction

Alhefzi

Voineskos

Coroneos

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: Abdominal-based perforator flaps are the gold standard for autologous breast reconstruction. However, among patients with a small-to-medium amount of redundant abdominal tissue, this may result in an inadequate breast mound. Secondary implant augmentation has been reported as one method to augment volume, address breast mound asymmetry, and enhance overall aesthetic outcome. We aim to analyze postoperative complications associated with the secondary implant augmentation following a primary breast reconstruction with abdominal perforator flaps. Methods: This retrospective study included patients who underwent secondary implant augmentation following abdominal-based perforator flap breast reconstruction. Patient characteristics, immediate versus delayed reconstruction, type of flap used, indication for secondary augmentation as well as perioperative and postoperative complication including flap or implant loss were reviewed and analyzed. Results: Twenty-four patients met inclusion criteria. Forty flaps were performed (16 bilateral and 8 unilateral). A total of 36 implants were placed in subpectoral plane in a secondary revision procedure. The mean time between secondary augmentation and index procedure was 22 months. Average implant volume was 270 g. No intraoperative complication or flap loss was recorded. Postoperative surgical site infection occurred in a total of 4 patients (17%) with 3 patients requiring explantation of a total of 4 implants. Conclusions: Secondary augmentation of abdominal-based perforator flap using a permanent implant is an effective method to address volume and asymmetry and to enhance aesthetic outcome. In our study, however, we observed a higher than expected rate of postoperative infection.

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Reducing Infection Rates in Implant-Based Breast Reconstruction

Cited by 36 publications

References 43 publications

Mastectomy and Prepectoral Reconstruction in an Ambulatory Surgery Center Reduces Major Infectious Complication Rates

Mastectomy and Prepectoral Reconstruction in an Ambulatory Surgery Center Reduces Major Infectious Complication Rates

Antibiotic Prophylaxis in Alloplastic Breast Reconstruction: Regimens and Outcomes

Secondary Implant Augmentation in the Subpectoral Plane following Abdominal-based Perforator Flaps for Breast Reconstruction

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