title: Postoperative Expansion is not a Primary Cause of Infection in Immediate Breast Reconstruction with Tissue Expanders.
abstract: Perioperative infection is the most common and dreaded complication associated with tissue expander (TE) breast reconstruction. Historically, the expansion period was thought to be the time of greatest hazard to the implant. However, recent institutional observations suggest infectious complications occur prior to expansion. This investigation, therefore, was conducted to determine the timing of infectious complications associated with two-stage TE breast reconstructions. Following IRB approval, a retrospective review of all consecutive two-stage immediate TE breast reconstructions at a single institution from November 2007 to November 2011 was conducted. Reconstructions were then divided into two cohorts: those suffering infectious complications and those that did not. Infectious complications including minor cellulitis, major cellulitis, abscess drainage, and explantation were identified. Various operative and patient variables were evaluated in comparison. Eight hundred ninety immediate two-stage TE breast reconstructions met inclusion criteria. Patients suffering infection were older (55.4 years versus 49.3 years; p < 0.001), and more likely to have therapeutic mastectomy (94% versus 61%; p < 0.0001), the use of acellular dermal matrix (ADM; 72.5% versus 54.9%; p = 0.001), and greater initial TE fill (448.6 mL versus 404.7 mL; p = 0.0078). The average time to developing of infectious symptoms was 29.6 days (range 9-142 days), with 94.6% (n = 87) of infections prior to the start of expansion. Perioperative infections in immediate two-stage TE to implant breast reconstructions are significant and occur mostly prior to the start of expansion. Thus, challenging the conventional wisdom that instrumentation during expander filling as the primary cause of implant infections. Possible etiologic factors include greater age, therapeutic mastectomy versus prophylactic mastectomy, larger initial TE fill, and the use of ADM.
authors.affiliation: Institute of Reconstructive Plastic Surgery, New York University, New York, New York.
authors.forename: Tomer
authors.initials: T
authors.lastname: Avraham
authors.affiliation: Institute of Reconstructive Plastic Surgery, New York University, New York, New York.
authors.forename: Katie E
authors.initials: KE
authors.lastname: Weichman
authors.affiliation: Institute of Reconstructive Plastic Surgery, New York University, New York, New York.
authors.forename: Stelios
authors.initials: S
authors.lastname: Wilson
authors.affiliation: Institute of Reconstructive Plastic Surgery, New York University, New York, New York.
authors.forename: Andrew
authors.initials: A
authors.lastname: Weinstein
authors.affiliation: University of Texas Southwestern, Dallas, Texas.
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Haddock
authors.affiliation: Department of Surgery, University Libre de Bruxelles, Brussels, Belgium.
authors.forename: Caroline
authors.initials: C
authors.lastname: Szpalski
authors.affiliation: Institute of Reconstructive Plastic Surgery, New York University, New York, New York.
authors.forename: Mihye
authors.initials: M
authors.lastname: Choi
authors.affiliation: Institute of Reconstructive Plastic Surgery, New York University, New York, New York.
authors.forename: Nolan S
authors.initials: NS
authors.lastname: Karp
mesh_terms: D000328:Adult; D001672:Biocompatible Materials / Q000008:administration & dosage / Q000009:adverse effects*; D019928:Breast Implantation / Q000009:adverse effects; D001943:Breast Neoplasms / Q000628:therapy*; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology* / Q000517:prevention & control; D015626:Tissue Expansion / Q000009:adverse effects* / Q000379:methods
chemical_list: D001672:Biocompatible Materials
keywords: breast cancer; breast reconstruction; tissue expander