Salvaging the Infected Breast Tissue Expander: A Standardized Multidisciplinary Approach

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.