Microbiologically confirmed tissue expander and breast implant infections: Evaluating risk factors for recurrence and...

In 2024, approximately 760,000 breast reconstructions were performed in the United States, including over 160,000 post-mastectomy procedures. Breast prosthesis infections, reported in 1-35% of cases, compromise esthetic outcomes, delay adjuvant therapy, and increase morbidity and recurrence risk. Data on predictors of recurrence and the impact of surgical strategies remain limited.

We conducted a single-center retrospective cohort study of adult women with microbiologically confirmed implant or tissue expander infections (2017-2024). The primary outcome was infection recurrence within 12 months of intervention. Secondary outcomes included post-operative complications (hematoma, seroma, capsular contracture, necrosis). Outcomes were compared across three surgical strategies - one-stage exchange, two-stage exchange, and explantation - using logistic regression and time-to-event analyses to assess recurrence-free survival.

67 implant and 107 tissue expander infections were included. Recurrence occurred in 16% of implant and 21% of tissue expander cases. One-stage exchange had the highest recurrence (38% implant, 60% tissue expander), while two-stage exchange and explantation were associated with lower recurrence rates. In multivariable models, these strategies were associated with reduced recurrence risk, although some comparisons did not reach statistical significance. Kaplan-Meier analysis demonstrated inferior recurrence-free survival with one-stage exchange. Among tissue expander cases, antibiotic spacer use was independently associated with increased recurrence risk (adjusted OR 5.38, 95% CI 1.06-27.22).

Two-stage exchange and explantation were associated with lower infection recurrence and may represent favorable strategies in selected patients. Delayed reconstruction should be considered when feasible. The association between spacer use and recurrence warrants further investigation.