Plastic Surgery Research Council

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Breast Implant Infections After First Stage Breast Reconstruction: A Case-Control Study of 272 patients
Joseph Banuelos, BA, M. Diya Sabbagh, MD, Si-Gyun Roh, MD, Minh-Doan Nguyen, MD, PhD, Nho V. Tran, MD, Judy C. Boughey, MD, Basel Sharaf, MD.
Mayo Clinic, Rochester, MN, USA.

PURPOSE: To determine risk factors for surgical site infections (SSI) after immediate implant-based breast reconstruction.
METHODS: After approval by our Institutional Review Board, a retrospective review identified 136 patients with breast implant infections between 2006 and 2016. Inclusion criteria encompassed patients who developed infection after immediate implant-based breast reconstruction (IBR) following therapeutic or prophylactic mastectomy. Only infections requiring hospital admission or surgical intervention were included. We matched 136 non-infected breast reconstruction patients by age and date of surgery. Patient demographics, medical comorbidities, and peri-operative surgical variables were examined. The Centers for Disease Control and Prevention definition of SSI was utilized. Univariate and Multivariate logistic regression models were constructed using STATA 16.0 software.
RESULTS: A total of 272 patients were evaluated. Univariate analysis demonstrated obesity, hypertension, history of smoking; neoadjuvant chemotherapy and previous radiation were significantly associated with developing an infection. Patients with heavier breasts, stage ≥IIA breast cancer, Nottingham score ≥2; and those requiring axillary lymph node dissection were also associated with infection. Post-operative duration of drain use was also associated with infection for every additional week. These results are summarized in tables 1-3.
After multivariate analysis, patients with obesity (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.02 to 1.16; p=0.003), invasive malignancy (OR, 2.5; 95% CI, 1.2 to 5.2; p=0.01), and longer post-operative duration of drain use (OR, 1.72; 95% CI, 1.22 to 2.42; p=0.002) were significantly associated with surgical site breast infection.

Pre-Operative Factors
VariableP value
Smoking0.009
Obesity0.006
Hypertension0.002
NeoadjuvantChemotherapy0.005
Previous Radiation0.037

Intra-Operative Factors
VariableP value
Breast cancer stage ≥IIA0.0001
Nottingham score ≥20.008
Lymph node dissection0.033
Heavier breasts0.0032

Post-Operative Factors
VariableP value
Increased duration of drain0.0012
Lymphedema0.013
Seroma0.0003
Skin necrosis0.0028
Wound dehiscence0.0018

CONCLUSION:
Infection after first stage breast reconstruction increases morbidity, health care costs and may delay cancer treatment. Patient characteristics, oncological features and surgical factors were associated with increased risk of infection. These results will help in patient counseling regarding infectious complications after implant-based reconstruction. Emphasis on modifiable peri-operative risk factors warrants further study.


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