Redefining infection management in implant-based breast reconstruction: Insights and innovations from an 11-year retrospective analysis

Glenda Giorgia Caputo; Anna Scarabosio; Jacopo Di Filippo; Alberto Pagotto; Carlo Tascini; Yanis Berkane; Pier Camillo Parodi

doi:10.1016/j.bjps.2024.10.037

Redefining infection management in implant-based breast reconstruction: Insights and innovations from an 11-year retrospective analysis

J Plast Reconstr Aesthet Surg. 2024 Oct 28:100:82-92. doi: 10.1016/j.bjps.2024.10.037. Online ahead of print.

Authors

Glenda Giorgia Caputo¹, Anna Scarabosio², Jacopo Di Filippo¹, Alberto Pagotto³, Carlo Tascini³, Yanis Berkane⁴, Pier Camillo Parodi¹

Affiliations

¹ Plastic Surgery Division, Department of Medical Area (DMED), University of Udine and Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy.
² Plastic Surgery Division, Department of Medical Area (DMED), University of Udine and Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy; Department of Plastic and Reconstructive Surgery Massachusetts General Hospital and Harvard Medical School, Boston 02114, MA, United States. Electronic address: [email protected].
³ Infectious Diseases Division, Department of Medicine (DMED), University of Udine and Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy.
⁴ Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, Rennes, France; SITI Laboratory, UMR1236, INSERM, Rennes University, Rennes, France; Vascularized Composite Allotransplantation Laboratory, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston 02114, MA, United States.

PMID: 39608140
DOI: 10.1016/j.bjps.2024.10.037

Abstract

Background: Infections associated with implant-based breast reconstructive surgery are challenging for both patients and surgeons, often implying high recurrence rate, long treatments (both medical and surgical management), multiple invasive procedures, and delay of the end-result and, in some cases, even reconstruction failure. Early diagnosis is crucial but not always easy to achieve. Various treatment options are available and have been described in literature, with no clear winning strategy. Recent improvements in microbiological and therapeutic tools have led the authors to question what would be considered the best plan for reconstruction salvage approach.

Methods: All patients who underwent implant-based breast reconstruction between 2012 and 2023 were enrolled. Clinical records regarding infections and treatment were retrospectively analyzed.

Results: Among a total of 506 patients, 26 (5.14%) developed implant-associated infections. Discussing the results, we realized that previous protocol was old-fashioned and required improvements. Through a multidisciplinary approach, a new prevention and treatment algorithm was derived. First, microbiological screening through nasal and rectal swab allows for proper decontamination prior to intervention. However, the keystone improvement consists in the use of molecular biology analysis, thus minimizing diagnosis timing and allowing targeted antibiotic therapy shortly after the removal of the infected implant. In addition, a fundamental role is played using instillation negative pressure wound therapy as a temporary spacer to ensure the maintenance of the periprosthetic pocket.

Conclusions: By following these precise steps in case of implant-associated infection, treatment can be optimized to reduce both therapy and hospitalization time, allowing the patient to achieve a reconstruction in a relatively short period.

Level of evidence: IV.

Keywords: Breast infection; Breast reconstruction; Film Array; Implant infection; Infection diagnosis; Molecular biology.