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Infection following Implant-Based Reconstruction in 1952 Consecutive Breast Reconstructions: Salvage Rates and Predictors of Success

Reish, Richard G. M.D.; Damjanovic, Branimir M.D.; Austen, William G. Jr. M.D.; Winograd, Jonathan M.D.; Liao, Eric C. M.D., Ph.D.; Cetrulo, Curtis L. M.D.; Balkin, Daniel M. Ph.D.; Colwell, Amy S. M.D.

Plastic & Reconstructive Surgery: June 2013 - Volume 131 - Issue 6 - p 1223–1230
doi: 10.1097/PRS.0b013e31828bd377
Breast: Original Articles

Background: Few studies address salvage rates for infection in implant-based breast reconstruction. An understanding of success rates and clinical predictors of failure may help guide management.

Method: A retrospective analysis of multisurgeon consecutive implant reconstructions from 2004 to 2010 was performed.

Results: Immediate implant-based reconstructions (n = 1952) were performed in 1241 patients. Ninety-nine reconstruction patients (5.1 percent) were admitted for breast erythema and had a higher incidence of smoking (p = 0.007), chemotherapy (p = 0.007), radiation therapy (p = 0.001), and mastectomy skin necrosis (p < 0.0001). There was no difference in age, body mass index, or acellular dermal matrix usage. With intravenous antibiotics, 25 (25.3 percent) reconstruction patients cleared the infection, whereas 74 (74.7 percent) underwent attempted operative salvage (n = 18) or explantation (n = 56). Patients who failed to clear infection had a higher mean white blood cell count at admission (p < 0.0001). Of the attempted operative salvage group, 12 cleared the infection with immediate implant exchange and six eventually lost the implant. Patients who failed implant salvage were more likely to have methicillin-resistant Staphylococcus aureus (p = 0.004). The total explantation rate was 3.2 percent. Following explantation, 32 patients underwent attempted secondary tissue expander insertion. Twenty-six were successful and six had recurrent infection and implant loss. There were no differences in time interval to tissue expander insertion between successful and unsuccessful secondary operations.

Conclusions: Salvage with intravenous antibiotics and implant exchange was successful in 37.3 percent of patients. Smoking, irradiation, chemotherapy, and mastectomy skin necrosis were predictors for developing infection. Patients with a higher white blood cell count at admission and methicillin-resistant S. aureus were more likely to fail implant salvage. There was no association with time interval to tissue expander insertion and secondary explantation.(Plast. Reconstr. Surg. 131: 1223, 2013.)

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Boston, Mass.

From the Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Received for publication August 7, 2012; accepted November 30, 2012.

Poster presentation at the 91st Annual Meeting of the American Association of Plastic Surgeons, in San Francisco, California, April 14 through 17, 2012; podium presentation at the 57th Annual Meeting of the Plastic Surgery Research Council, in Ann Arbor, Michigan, June 14 through 16, 2012; and at Plastic Surgery: The Meeting, Annual Meeting of the American Society of Plastic Surgeons, in New Orleans, Louisiana, October 26 through 30, 2012.

Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, Boston, Mass. 02114, acolwell@partners.org

©2013American Society of Plastic Surgeons