Infections after mastectomy and tissue expander placement: A multivariate regression analysis

Area of Science:

• Plastic Surgery
• Surgical Site Infections
• Breast Reconstruction

Background:

• Tissue expander-based breast reconstruction (TE-BR) has significantly higher infection rates (up to 31%) compared to standard breast surgery.
• Identifying risk factors for TE-BR infections is crucial for improving patient outcomes.

Purpose of the Study:

• To analyze risk factors contributing to infections following tissue expander placement during breast reconstruction.
• To evaluate the impact of drain retention duration and post-operative antibiotic use on infection rates.

Main Methods:

• A retrospective study analyzed 311 patients undergoing mastectomy with tissue expander (TE) placement over 22 months.
• Infections were defined by clinical documentation, return to operating room, or positive cultures.
• Multivariate logistic regression identified significant risk factors for infection.

Main Results:

• 13.5% of breasts developed infection before the second stage reconstruction.
• Infection risk increased with patient age (OR 1.04), full-thickness necrosis (OR 6.64), seromas requiring drainage (OR 2.79), and longer drain therapy (OR 1.04).
• Extended post-operative antibiotic duration did not reduce infection rates.

Conclusions:

• Key risk factors for TE-BR infections include advanced patient age, prolonged drain use, seromas, and tissue necrosis.
• Current antibiotic protocols may not be sufficient to prevent infections in TE-BR.
• Further prospective research is needed to optimize antibiotic strategies and reduce morbidity in TE-BR patients.