Posted on June 14, 2013
Journal time: June 2013 Plastic & Reconstructive Surgery Journal had an article on “Infection Following Implant based Reconstruction in 1952 Consecutive Breast Reconstructions: Salvage Rates and Predictors of Success.”
Long title, but what it is talking about is:
IF your breast cancer reconstruction implant presents with an infection (redness, discharge, etc), can you save the implant? And is there a way to predict when you should try?
Study: Out of Boston. Retrospective study of consecutive reconstructions 2004-2010. There were 1952 reconstructions.
Findings?
- 99 patients (5%) were admitted for redness.
- These patients had a higher incidence of smoking, chemotherapy, radiation, and mastectomy skin loss
- There was NO difference in a age, BMI, or use of acellular dermal matrix
- Treatments were done with IV antibiotics
- 25% cleared the infection
- 74% had attempted operation salvage or explant
- Of those who tried to salvage, 1/2 were redone with a new implant, but half of those eventually lost the new implant.
- Of those who explanted, attempts to insert a tissue expander later were successful 75% of the time.
Conclusions?
- Salvage with IV antibiotics and implant exchange was successful 37% of the time (! This number was higher than I would expect, though infection and redness come in all kinds of levels of how infected it looks at the time of presentation. )
- Smoking, radiation, chemo, and mastectomy flap issues were predictors of forming an infection
- Higher WBC count at admission signified higher chance of failure
- MRSA had higher chance of failure