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Infection Outcomes in Implant-Based Breast Reconstruction: Five-Year Experience with the GAPS Protocol
Bo Hyun Kong1, Omar Jean-Baptiste1, Owen Brown2
1. Emory University School of Medicine, Atlanta, Georgia, USA.
Plastic and Reconstructive Surgery
|July 14, 2026
Summary
The Gloves, Antimicrobial soak, Pocket irrigation, and Sterile field (GAPS) protocol significantly reduced surgical-site infections in breast reconstruction patients. This structured approach offers a promising strategy for improving patient outcomes and lowering healthcare costs.
Area of Science:
- Plastic Surgery
- Infectious Disease Prevention
- Surgical Outcomes
Background:
- Surgical-site infections (SSI) are a significant complication following implant-based breast reconstruction (IBBR).
- Currently, no universally adopted protocol exists for SSI prevention in IBBR.
- The GAPS (Gloves, Antimicrobial soak, Pocket irrigation, Sterile field) protocol was developed to address this gap.
Purpose of the Study:
- To evaluate the effectiveness of the 12-step GAPS protocol in reducing SSI rates after IBBR.
- To assess the impact of a structured infection prevention protocol on reconstructive surgery outcomes.
Main Methods:
- A quasi-experimental prospective cohort study with historical controls was conducted.
- The GAPS protocol was implemented in December 2019, with a 90-day postoperative follow-up period.
- SSI rates were compared between the protocol cohort and historical controls, with calculation of relative risk (RR), absolute risk reduction (ARR), and number needed to treat (NNT).
Main Results:
- The GAPS protocol cohort (604 patients) demonstrated a lower SSI rate (5.7%) compared to the control group (8.7%, P = .03).
- Adjusted analyses showed the protocol remained directionally protective, with a direct effect RR of 0.66 (95% CI 0.43-1.01; P = .053) when adjusting for seroma.
- Protocol adherence was approximately 80%, yielding an ARR of 2.96% and an NNT of 34.
Conclusions:
- The GAPS protocol is associated with a reduction in SSI following IBBR.
- Structured perioperative infection prevention protocols can improve reconstructive surgery outcomes.
- Implementation of the GAPS protocol shows potential for reducing the healthcare burden associated with SSIs.