Intraoperative Predictors of Salvage in Infected Breast Implants: A Retrospective Study

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Infectious Disease in Surgery

Background:

• Infectious complications following implant-based breast reconstruction (IBBR) can lead to reconstructive failure.
• While demographic risk factors are known, intraoperative predictors of failure after salvage attempts are less understood.

Purpose of the Study:

• To identify intraoperative findings during infected breast reconstruction that predict implant failure.
• To inform intraoperative decision-making and improve salvage success rates.

Main Methods:

• Retrospective review of intraoperative records for 837 patients undergoing IBBR (January 2017 - July 2023).
• Focus on patients who developed major infections (n=71).
• Definitions: Salvage (intervention without explantation), Failure (explantation).

Main Results:

• Major infection occurred in 8% of patients; 53.5% experienced reconstructive failure.
• Unincorporated acellular dermal matrix (ADM) was found in 51% of patients requiring reoperation and was significantly associated with reconstructive failure (OR 5.4, P=.003).
• Common pathogens included Staphylococcus aureus (MSSA/MRSA), Serratia, Enterobacter, Pseudomonas, and Proteus. Serratia, hematoma, and gram-negative infections showed trends toward implant failure but lacked statistical significance.

Conclusions:

• The presence of unincorporated ADM during infected breast reconstruction is a significant predictor of eventual implant failure.
• Awareness of unincorporated ADM intraoperatively can guide surgical decisions and potentially improve outcomes in patients undergoing salvage procedures.