Tissue Expander Salvage after Postoperative Infection Depending on Plane of Placement in Breast Reconstruction

Conservative management with antibiotic therapy may enable implant salvage following infection after device-based breast reconstruction. No existing studies describe the likelihood of implant salvage with respect to the plane of reconstruction in a large patient cohort.

Patients who underwent device-based breast reconstruction and experienced postoperative infections from January of 2013 to August of 2023 were reviewed retrospectively. Device salvage, the main outcome of interest, was characterized as resolution of infection from management without explantation. Multivariable logistic regression was used to quantify predictors of salvage versus explantation ( P < 0.05).

A total of 2019 breasts in 1206 patients were analyzed. Planes of placement included total submuscular (73.9%), subpectoral with acellular dermal matrix (ADM) (14.0%), prepectoral with ADM (10.5%), and prepectoral without ADM (1.6%). Postoperative infection occurred in 86 breasts (4.3%). The infection rate was highest in subpectoral procedures (8.9%), followed by prepectoral with ADM (8.0%), prepectoral without ADM (6.3%), and total submuscular placement (2.8%). Prepectoral with ADM (OR, 2.79; 95% CI, 1.46 to 5.33; P = 0.0019) and subpectoral (OR, 3.67; 95% CI, 2.15 to 6.24; P < 0.001) placement predicted higher likelihood of infection compared with total submuscular placement, but neither plane predicted significantly different odds of salvage after infection ( P > 0.05).

Management of infection in device-based reconstruction without explantation is a reasonable treatment option with resolution of infection in 36% of cases. Although total submuscular placement confers protection against postoperative infection compared with other planes of placement, it does not add benefit for subsequent success of device salvage.