Reducing surgical site infection in implant-based breast reconstruction: Impact of preoperative Staphylococcus aureus...

Implant-based breast reconstruction (BR) is widely performed after curative or prophylactic mastectomy. Surgical site infection (SSI) is a frequent and dreaded complication that is known to compromise the outcomes of BR. Nasal carriage of Staphylococcus aureus is a known risk factor for SSI. Preoperative nasal screening followed by decolonisation in case of positive result has been offered at the Oscar Lambret Centre since 2018. In this study, we evaluated the association between the realisation of an S. aureus screening and decolonisation programme on the risk of SSI after breast implant placement.

This single-centre retrospective cohort study included all patients who underwent breast implant placement between 01/05/2018 and 01/05/2023, with follow-up until 01/05/2024. The primary endpoint was SSI within 12 months, confirmed via centralised review of clinical and microbiological data. Associations were analysed using generalised estimating equations to account for clustering of implants in patients. Multivariable analyses were adjusted for potential confounders.

Overall, 738 patients (median age 47.3 years) and 1385 implants were included. Preoperative screening was performed in 73.9% of the procedures. The 12-month SSI incidence was 5.8% (95% confidence interval [CI] 4.7-7.2). Screening was independently associated with reduced infection risk (OR=0.59; 95% CI 0.35-0.98; p=0.041). Obesity and type of reconstruction were significantly associated with infection risk (p<0.001), compared to implant mastopexy procedures or implant changes, the risk appeared to be significantly increased after immediate BR (OR=2.61; 1.62-4.22) contrasting with delayed BR (OR=0.67; 0.21-2.15).

This study suggests that nasal screening for S. aureus followed by decolonisation is effective in reducing the risk of infection after breast implant placement.