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Breast Reconstruction with Tissue Expanders: Implementation of a Standardized Best-Practices Protocol to Reduce Infection Rates

Khansa, Ibrahim M.D.; Hendrick, Russell G. Jr M.D.; Shore, Alison M.D.; Meyerson, Joseph M.D.; Yang, Maelee B.S.; Boehmler, James H. IV M.D.

Plastic and Reconstructive Surgery: July 2014 - Volume 134 - Issue 1 - p 11–18
doi: 10.1097/PRS.0000000000000261
Breast: Outcomes Articles
Coding Perspective

Background: Periprosthetic infection remains a frustrating and costly complication of breast reconstruction with tissue expanders. Although some specific steps have been previously shown to reduce periprosthetic infections, no comprehensive protocol addressing all aspects of preoperative, intraoperative, and postoperative patient management has been evaluated in the literature. The authors’ goal was to evaluate the effectiveness of their protocol at reducing periprosthetic infections.

Methods: A comprehensive, best-practices protocol was introduced and implemented in November of 2010. All patients undergoing breast reconstruction using tissue expanders at the authors’ institution in the 5 years before the protocol, and in the 2 years after, were analyzed.

Results: Three hundred five patients underwent 456 tissue expander reconstructions in the 5 years before the protocol, and 198 patients underwent 313 reconstructions in the 2 years after. Significantly fewer patients developed periprosthetic infection after protocol (11.6 percent versus 18.4 percent; p = 0.042), and the number of infected tissue expanders trended toward a decrease (9.3 percent versus 13.2 percent; p = 0.097). On multivariate analysis, the protocol significantly reduced the odds of periprosthetic infection (OR, 0.45; p = 0.022). Predictors of infection included obesity (OR, 2.01; p = 0.045) and preoperative breast size larger than C cup (OR, 2.83; p = 0.006).

Conclusions: The authors’ comprehensive, best-practices protocol allowed them to reduce the odds of tissue expander infections by 55 percent (OR, 0.45; p = 0.022). The authors were able to identify several potential areas of improvement that may help them lower the rate of infection further in the future.


Coding Perspective for this article is on page 17.

Columbus, Ohio; Houston, Texas; and Chicago, Ill.

From the Department of Plastic Surgery, The Ohio State University Wexner Medical Center; the Division of Plastic Surgery, Baylor College of Medicine; and Lakeview Plastic Surgery.

Received for publication November 30, 2013; accepted January 15, 2014.

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

James H. Boehmler IV, M.D., Department of Plastic Surgery, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Suite 2100, Columbus, Ohio 43212,

©2014American Society of Plastic Surgeons