Critical Evaluation of Risk Factors of Infection Following 2-Stage Implant-Based Breast Reconstruction

Infection is a dreaded complication following 2-stage implant-based breast reconstruction that can prolong the reconstructive process and lead to loss of implant. This study aimed to characterize outcomes of reconstructions complicated by infection, identify patient and surgical factors associated with infection, and use these to develop an infection management algorithm. METHODS We performed a retrospective review of all consecutive implant-based breast reconstructions performed by the senior author (2006-2015) and collected data regarding patient demographics, medical history, operative variables, presence of other complications (necrosis, seroma, hematoma), and infection characteristics. Univariate and multivariate binomial logistic regression analyses were performed to identify independent predictors of infection. RESULTS We captured 292 patients who underwent 469 breast reconstructions. In total, 14.1% (n = 66) of breasts were complicated by infection, 87.9% (n = 58) of those were admitted and given intravenous antibiotics, 80.3% (n = 53) of all infections were cleared after the first attempt, whereas the remaining recurred at least once. The most common outcome was explantation (40.9%; n = 27), followed by secondary implant insertion (21.2%; n = 14) and operative salvage (18.2%; n = 12). Logistic regression analysis demonstrated that body mass index (P = 0.01), preoperative radiation (P = 0.02), necrosis (P < 0.001), seroma (P < 0.001), and hematoma (P = 0.03) were independent predictors of infection. CONCLUSIONS We observed an overall infectious complication rate of 14.1%. Heavier patients and patients who received preoperative radiation were more likely to develop infectious complications, suggesting that closer monitoring of high risk patients can potentially minimize infectious complications. Further, more aggressive management may be warranted for patients whose operations are complicated by necrosis, seroma, or hematoma.