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Late Surgical-Site Infection in Immediate Implant-Based Breast Reconstruction

Sinha, Indranil M.D.; Pusic, Andrea L. M.D., M.H.S.; Wilkins, Edwin G. M.D., M.S.; Hamill, Jennifer B. M.P.H.; Chen, Xiaoxue M.S.; Kim, Hyungjin M. Sc.D.; Guldbrandsen, Gretchen B.A.; Chun, Yoon S. M.D.

Plastic and Reconstructive Surgery: January 2017 - Volume 139 - Issue 1 - p 20-28
doi: 10.1097/PRS.0000000000002839
Breast: Original Articles
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Background: Surgical-site infection causes devastating reconstructive failure in implant-based breast reconstructions. Large national database studies offer insights into complication rates, but only capture outcomes within 30 days postoperatively. This study evaluates both early and late surgical-site infection in immediate implant-based reconstruction and identifies predictors.

Methods: As part of the Mastectomy Reconstruction Outcomes Consortium Study, 1662 implant-based breast reconstructions in 1024 patients were evaluated for early versus late surgical-site infection. Early surgical-site infection was defined as infection occurring within 30 days postoperatively; late surgical-site infection was defined as infection occurring 31 days to 1 year postoperatively. Minor infection required oral antibiotics only, and major infection required hospitalization and/or surgical treatment. Direct-to-implant patients had 1-year follow-up, and tissue expander patients had 1-year post-exchange follow-up.

Results: Among 1491 tissue expander and 171 direct-to-implant reconstructions, overall surgical-site infection rate for tissue expander was 5.7 percent (85 of 1491) after first-stage, 2.5 percent (31 of 1266) after second-stage, and 9.9 percent (17 of 171) for direct-to-implant reconstruction. Over 47 to 71 percent of surgical-site infection complications were late surgical-site infection. Multivariate analysis identified radiotherapy and increasing body mass index as significant predictors of late surgical-site infection. No significant difference between the direct-to-implant and tissue expander groups in the occurrence of early, late, or overall surgical-site infection was found.

Conclusions: The majority of surgical-site infection complications in immediate implant-based breast reconstructions occur more than 30 days after both first-stage and second-stage procedures. Radiotherapy and obesity are significantly associated with late-onset surgical-site infection. Current studies limited to early complications do not present a complete assessment of infection associated with implant-based breast reconstructions or their long-term clinical outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

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Boston, Mass.; New York, N.Y.; and Ann Arbor, Mich.

From the Division of Plastic Surgery, Brigham and Women’s Hospital; the Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center; and the Section of Plastic Surgery and the Center for Statistical Consultation and Research, University of Michigan.

Received for publication February 22, 2016; accepted August 4, 2016.

Disclosure:The authors have no conflicts of interest or disclosures.

Yoon S. Chun, M.D., Division of Plastic Surgery, Brigham and Women’s Hospital/Faulkner Hospital, 1153 Centre Street, Suite 21, Boston, Mass. 02130, ychun@partners.org

Copyright © 2016 by the American Society of Plastic Surgeons