A Breast Prosthesis Infection Update: Two-Year Incidence, Risk Factors and Management at Single Institution

Authors

Ashley Nadia Boustany, University of KentuckyFollow
Shady Elmaraghi, University of Wisconsin-Madison
Nneamaka Agochukwu, University of KentuckyFollow
Benjamin Cloyd, University of KentuckyFollow
Adam J. Dugan, University of KentuckyFollow
Brian Rinker, University of KentuckyFollow

Abstract

Background: Infection following augmentation and prosthetic-based breast reconstruction can cause significant physical and psychological distress for patients. It may delay adjuvant therapies and compromise aesthetic outcomes. The aim of this study is to identify modifiable risk factors for infection and identify common bacterial isolates to achieve optimal outcomes for patients.

Methods: A retrospective cohort study was performed for patients undergoing implant-based breast reconstruction over a 2-year period. In each case, we documented demographics, co-morbidities, complications and antibiotic use. We reviewed treatments, infectious species cultured where applicable and all outcomes.

Results: A total of 292 patients met the inclusion criteria. Fifty-five patients (19%) developed an infection. Univariate analysis showed a significantly increased infection rate with longer operative times (P = 0.001) and use of tissue expanders (P = 0.001). Multiple logistic regression analysis confirmed drain use and elevated body mass index (BMI) as risk factors (odds ratio [OR] 2.427 and 1.061, respectively). After controlling for BMI, smoking status and radiation, we found an increased odd of infection with allograft use (OR 1.838) and a decreased odd with skin preparation using 2% chlorhexidine gluconate in 70% isopropyl (OR 0.554), though not statistically significant. Forty of 55 patients with infections had cultures, with 62.5% of isolates being Gram-positive species and 30% Gram-negative species. The median time to clinical infection was 25 days. Implant salvage with surgical interventions was achieved in 61.5% of patients.

Conclusions: This study identified judicious use of drains and efficiency in the operating room as modifiable risk factors for infections following implant-based breast reconstruction. Prospective trials to analyse techniques for infection prevention are warranted. Implant salvage following infection is a possible end-point in the appropriate patient.

Document Type

Article

Publication Date

1-2018

Notes/Citation Information

Published in Indian Journal of Plastic Surgery, v. 51, issue 1, p. 7-14.

© 2018 Indian Journal of Plastic Surgery

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commericially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Digital Object Identifier (DOI)

https://doi.org/10.4103/ijps.IJPS_215_17

Related Content

Tables

Table 1: Patient characteristics and risk factors

Table 2: Risk factors for infection in the reconstructive cohort

Table 3: Surgical prep solutions

Table 4: Patient characteristics and outcomes among patients with infections

Table 5: Summary of the reduced multiple logistic regression model for predicting infection among reconstructions (n=260)

Table 6: Isolated species in the infection cohort

Repository Citation

Boustany, Ashley Nadia; Elmaraghi, Shady; Agochukwu, Nneamaka; Cloyd, Benjamin; Dugan, Adam J.; and Rinker, Brian, "A Breast Prosthesis Infection Update: Two-Year Incidence, Risk Factors and Management at Single Institution" (2018). Surgery Faculty Publications. 32.
https://uknowledge.uky.edu/surgery_facpub/32