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Salvaging the Infected Breast Tissue Expander: A Standardized Multidisciplinary Approach.

George M Viola1, Jesse C Selber1, Melissa Crosby1

  • 1Departments of Infectious Diseases, Plastic Surgery, and Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex.

Plastic and Reconstructive Surgery. Global Open
|August 3, 2016
PubMed
Summary
This summary is machine-generated.

A new same-day protocol for breast tissue expander (TE) infections successfully salvaged TEs in 73% of patients. This approach reduced hospitalizations and costs, offering a better alternative to TE removal for early infection signs.

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Area of Science:

  • Plastic Surgery
  • Infectious Diseases
  • Quality Improvement

Background:

  • Breast tissue expander (TE) infections often necessitate removal and hospitalization, delaying adjuvant therapy and increasing reconstruction costs.
  • A standardized, same-day, multidisciplinary outpatient protocol was developed to manage early TE infection signs, aiming to reduce TE removal rates, hospitalizations, and costs.

Purpose of the Study:

  • To evaluate the efficacy of a novel same-day multidisciplinary protocol for diagnosing and treating early breast tissue expander infections.
  • To improve tissue expander (TE) salvage rates and reduce associated healthcare burdens.

Main Methods:

  • A prospective study of 26 patients with surgical site infections post-breast tissue expander placement.
  • Implementation of a same-day protocol involving Plastic Surgery and Infectious Diseases consultations, breast ultrasonography with possible fluid aspiration, and standardized antimicrobial therapy.
  • Patient follow-up for a minimum of 1 year to assess treatment outcomes.

Main Results:

  • Tissue expander (TE) salvage was achieved in 73% (19/26) of patients.
  • Patients requiring TE explantation presented with shorter median time to infection and higher median temperatures compared to salvaged patients.
  • TE salvage rates varied by microbial growth: 92% for no growth, 75% for Staphylococcus, and 0% for Pseudomonas. Deep-seated infections were more likely to result in TE explantation (P=0.021).

Conclusions:

  • The developed same-day multidisciplinary algorithm significantly improved TE salvage rates compared to previous reports.
  • This protocol effectively decreased hospitalization rates and overall costs associated with TE infections.
  • The study identified specific clinical factors, such as deep-seated infection and certain microbial profiles, associated with a higher likelihood of TE explantation.