Management of the Infected Tissue Expander

Area of Science:

• Plastic Surgery
• Breast Reconstruction
• Surgical Complications

Background:

• Tissue expander infection is a significant complication in two-stage implant-based breast reconstruction.
• Identifying risk factors and salvage rates is crucial for improving patient outcomes.

Purpose of the Study:

• To assess risk factors for tissue expander infection and reconstructive loss.
• To examine reconstructive salvage rates following infection.

Main Methods:

• Retrospective review of 305 patients with tissue expander infection undergoing two-stage implant-based breast reconstruction (2017-2022).
• Analysis included patients treated with antibiotics, interventional radiology drainage, and/or operative management.
• Reconstructive success defined as maintenance of reconstruction for 1 year post-tissue expander placement.

Main Results:

• Higher BMI, hypertension, radiation, bilateral expanders, acellular dermal matrix, increased mastectomy weight, and nipple-sparing mastectomy were linked to higher infection risk.
• Patients with tissue expander infection had a 54% 1-year reconstructive failure rate.
• Black race and Gram-negative cultures increased the hazard of reconstructive failure; implant replacement showed the best success rate.

Conclusions:

• Overall, 46% of patients with periprosthetic infection achieved successful salvage.
• Intravenous antibiotics and early operative intervention are recommended for tissue expander infections.
• Practice is shifting from interventional radiology drainage to definitive operative management for periprosthetic infections.