Seroma volume as early indicator for infection in tissue expander-based breast reconstruction

Infection is a common and impactful complication following tissue expander (TE)-based breast reconstruction. Seroma is known to be a significant risk factor for infection. Dual-port TE devices facilitate seroma aspiration and quantification postoperatively. We hypothesized that aspiration volume could serve as a predictor of TE infection after drain removal.

A retrospective review of 180 breasts in 118 patients who underwent immediate prepectoral dual-port TE-based reconstruction was conducted. Timing of infections was delineated based on drain removal. Logistic regression was used to identify infection predictors. Receiver-operating-characteristic (ROC) analysis was used to evaluate the ability of aspiration volume to predict post-drain removal infections. Paired tests were used to compare aspiration volumes between bilateral breasts among infected and non-infected patients.

Infection occurred in 35 breasts (19.4%): 16 pre-drain removal and 19 post-drain removal. Infections before drain removal were significantly associated with extended drain duration (OR 1.14, p = 0.024). Post-drain removal infections were significantly associated with higher median aspiration volumes (40.0 mL vs. 3.0 mL, p < 0.001). ROC analysis yielded an AUC of 0.77, with a predictive volume threshold of 18.04 mL. Bilateral comparison confirmed higher aspiration volumes in infected breasts (mean difference 23.59 mL, p = 0.01).

TE infections follow a bimodal distribution. Infections occurring prior to drain removal correlate with duration of drain use, whereas infections post-drain removal correlate with increased postoperative seroma volume. Increased aspiration volumes signal impending infection and may benefit from intervention to prevent florid infection and potential implant loss.