title: Late Surgical-Site Infection in Immediate Implant-Based Breast Reconstruction.
abstract: 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.
  
  
  METHODS
  Risk, II.
authors.affiliation: 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.
authors.forename: Indranil
authors.initials: I
authors.lastname: Sinha
authors.affiliation: 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.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Pusic
authors.affiliation: 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.
authors.forename: Edwin G
authors.initials: EG
authors.lastname: Wilkins
authors.affiliation: 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.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Hamill
authors.affiliation: 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.
authors.forename: Xiaoxue
authors.initials: X
authors.lastname: Chen
authors.affiliation: 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.
authors.forename: Hyungjin M
authors.initials: HM
authors.lastname: Kim
authors.affiliation: 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.
authors.forename: Gretchen
authors.initials: G
authors.lastname: Guldbrandsen
authors.affiliation: 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.
authors.forename: Yoon S
authors.initials: YS
authors.lastname: Chun
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019928:Breast Implantation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008408:Mastectomy; D008875:Middle Aged; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors; D055815:Young Adult