Reducing Infectious Complications in Implant Based Breast Reconstruction

Hanna, Kasandra R.; Tilt, Alexandra; Holland, Michael; Colen, David L.; Bowen, Byers; Stovall, Madeline; Lee, Andy Chao Hsuan; Wang, Jessica; Drake, David B.; Lin, Kant Y.; Uroskie, Theodore; Campbell, Chris A.

doi:10.1097/sap.0000000000000760

Cited by 52 publications

(45 citation statements)

References 12 publications

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“…Instead, we injected the tissue expander on postoperative day 14. Hanna et al [9] recommended early expansion of tissue expander on postoperative day 21 to reduce infectious complications. They also found an association between infection and drain duration greater than 21 days.…”

Section: Discussionmentioning

confidence: 99%

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Risk of infection is associated more with drain duration than daily drainage volume in prosthesis-based breast reconstruction

et al. 2016

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In prosthesis-based breast reconstruction, drains are used to prevent seroma formation and to reduce the risk of infection. However, prolonged drainage increases the risk of ascending infection. Although the volume often accepted for drain removal is ≤30 mL per day, the optimal timing to remove the drain for best clinical outcome remains controversial.We did a retrospective cohort study of 569 patients of prosthesis-based breast reconstruction with infection rate as the outcome variable; drain duration and last daily drainage volume as the main independent variables. Data on age, smoking history, diabetes mellitus history, body mass index, breast weight, tissue expander size, drain size, number of retrieved lymph nodes, tumor size, number of metastatic lymph nodes, tumor stage, mastectomy type, reconstruction type, submuscular implantation, skin defect, operative time, duration of antibiotics use, chemotherapy, and radiotherapy were collected as covariates. Multivariable logistic regression analysis was used to control for confounding.The total infection rate was 5.1% (29/569). The daily drainage volume ≥30 mL/d at the time of drain removal was not found associated with increased infection rate (P = 0.32). Of the various cutoff values of last daily drainage volume, none was found to be a determinant for drain removal where the risk of infection was concerned. By contrast, drain duration over 21 days significantly increased infection rate (P = 0.001). The multivariable logistic regression analysis showed an increase of 76.2% in the infection rate with each additional week of drain retention (P = 0.001). Breast weight also had a significant influence on risk of infection. Chemotherapy and drain size showed borderline effect on risk of infection whereas the last daily drainage volume was not associated with risk of infectionIn summary, our study revealed that drain duration, rather than the last daily drainage volume, significantly affects the infection rate in prosthesis-based breast reconstruction. We recommend that the drain is better removed no longer than 3 weeks postoperatively and can be removed as early as postoperative day 7, even when the drainage is over 30 mL in a 24-hour period.

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Section: Discussionmentioning

confidence: 99%

“…Most surgeons (87.4%) recommend drain removal when the daily drainage volume at the time of drain removal (defined as last daily drainage volume) drops below 30 mL. [3,8,9] Some recommend 20 mL, or 50 mL. [3,10,11] …”

Section: Introductionmentioning

confidence: 99%

Risk of infection is associated more with drain duration than daily drainage volume in prosthesis-based breast reconstruction

et al. 2016

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“…Consequently to high probability of this complication same authors recommend autologous reconstruction instead of tissue expander-based reconstruction in patients who require mastectomy and axillary lymph node dissection (11). Other authors however, while discussing prolonged drain usage as an independent source of infection causing delayed healing, suggest early tissue expansion, associated with earlier drain removal as a way to avoid infectious complications (39). It has to be underlined that postoperative rehabilitation including exercises and self-massage could be a way of preventing and managing secondary lymphedema thus minimizing the risk of failure of reconstruction process due to this complication.…”

Section: Axillary Lymph Node Dissectionmentioning

confidence: 99%

Impact of different type of cancer treatment on the effectiveness of breast reconstruction

et al. 2016

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For women undergoing mastectomy as part of their breast cancer treatment, breast reconstruction is an important part of therapy. However, neoadjuvant, adjuvant treatments as well as other patient-related factors can compromise the results of breast reconstruction techniques. In this article we have reviewed current approaches to the management of complications and risks that neoadjuvant and adjuvant therapies pose on breast reconstruction after mastectomy for breast cancer. Non-treatment related factors influencing reconstruction techniques were reviewed as well.

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“…While autologous tissue provides the most natural and lasting outcomes, implant-based breast reconstruction continues to be the more popular option, accounting for close to 80% of procedures 1,2. Reasons for this include no donor-site morbidity, shorter procedures, a younger patient population, a lack of autologous donor tissue, and a rise in bilateral mastectomies 3,4…”

Section: Introductionmentioning

confidence: 99%

“…Infection of prostheses can lead to complications, ranging from the mild, such as superficial cellulitis, to the severe, including repeated procedures for chronic wounds, implant failure, and life-threatening sepsis 9. Specific to breast implants, infection can lead to the development of persistent biofilm and capsular contracture, rib osteomyelitis, and delay in oncologic treatments 2,10…”

Section: Introductionmentioning

confidence: 99%

Reducing infection risk in implant-based breast-reconstruction surgery: challenges and solutions<div><br /></div>

Ooi

Song

2016

BCTT

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Implant-based procedures are the most commonly performed method for postmastectomy breast reconstruction. While donor-site morbidity is low, these procedures are associated with a higher risk of reconstructive loss. Many of these are related to infection of the implant, which can lead to prolonged antibiotic treatment, undesired additional surgical procedures, and unsatisfactory results. This review combines a summary of the recent literature regarding implant-related breast-reconstruction infections and combines this with a practical approach to the patient and surgery aimed at reducing this risk. Prevention of infection begins with appropriate reconstructive choice based on an assessment and optimization of risk factors. These include patient and disease characteristics, such as smoking, obesity, large breast size, and immediate reconstructive procedures, as well as adjuvant therapy, such as radiotherapy and chemotherapy. For implant-based breast reconstruction, preoperative planning and organization is key to reducing infection. A logical and consistent intraoperative and postoperative surgical protocol, including appropriate antibiotic choice, mastectomy-pocket creation, implant handling, and considered acellular dermal matrix use contribute toward the reduction of breast-implant infections.

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Reducing Infectious Complications in Implant Based Breast Reconstruction

Cited by 52 publications

References 12 publications

Risk of infection is associated more with drain duration than daily drainage volume in prosthesis-based breast reconstruction

Risk of infection is associated more with drain duration than daily drainage volume in prosthesis-based breast reconstruction

Impact of different type of cancer treatment on the effectiveness of breast reconstruction

Reducing infection risk in implant-based breast-reconstruction surgery: challenges and solutions<div><br /></div>

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