Bottosso Stefano, Sidoti Giulia Benedetta, Vita Ludovica, Scian Alessandro, Bonat Guarini Luigi, Renzi Nadia, Ramella Vittorio, Papa Giovanni
Plastic Surgery Department, Ospedale di Cattinara, ASUGI, Strada di Fiume, 447, 34149 Trieste, Italy.
Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery Unit, University of Trieste, 34149 Trieste, Italy.
Cancers (Basel). 2024 Jul 2;16(13):2439. doi: 10.3390/cancers16132439.
With the rise in the mastectomy rate, the number of patients who choose to undergo postmastectomy reconstruction has been increasing, and implant-based procedures are the most performed methods for postmastectomy breast reconstruction. Among the possible complications, the most feared is the loss of reconstruction. It can be related to several reasons, but one of the most common is infection of the implant, which can lead to prolonged antibiotic treatment, undesired additional surgical procedures, increased incidence of capsular contracture, and unsatisfactory aesthetics results, with a huge psychological impact on patients.
The primary intent of this study is to analyze the status of infection rates at our institution and evaluate the effectiveness of our prevention protocol since its introduction. Secondly, we compared data of the surgical site infections (SSIs) after implant-based breast reconstruction at Trieste Hospital, where the protocol has been employed since 2020, and in another center, where plastic surgeons of our team are involved, with different prevention procedures.
We enrolled 396 female patients, who underwent implant-based breast reconstruction, using definitive mammary implants or breast tissue expanders, with or without ADM (acellular dermal matrix), both for breast cancer and risk-reducing surgery in BRCA1/2 patients. Patients treated at the Hospital of Trieste, with the use of the prevention protocol, were considered the experimental group (group 1), while patients treated in Gorizia by the same breast team with standardized best-practice rules, but without the use of the prevention protocol, were considered the control group (group 2). Infected patients were 5 in the first group (1.7%) and 8 in the second one (7.9%), with a global infection rate of 3.2%.
After the introduction of our prevention protocol, we faced a lower incidence of infection after breast surgery with implants or tissue expanders.
随着乳房切除术率的上升，选择进行乳房切除术后重建的患者数量一直在增加，而基于植入物的手术是乳房切除术后乳房重建最常用的方法。在可能的并发症中，最令人担忧的是重建失败。其可能与多种原因有关，但最常见的原因之一是植入物感染，这可能导致抗生素治疗时间延长、不必要的额外手术、包膜挛缩发生率增加以及美学效果不理想，对患者造成巨大的心理影响。
本研究的主要目的是分析我们机构的感染率状况，并评估自引入预防方案以来其有效性。其次，我们比较了的里雅斯特医院自2020年起采用该方案后以及我们团队的整形外科医生参与的另一个采用不同预防程序的中心，基于植入物的乳房重建术后手术部位感染（SSI）的数据。
我们纳入了396例接受基于植入物的乳房重建的女性患者，她们使用确定性乳房植入物或乳房组织扩张器，无论是否使用脱细胞真皮基质（ADM），均用于乳腺癌手术以及BRCA1/2基因缺陷患者的降低风险手术。在的里雅斯特医院使用预防方案治疗的患者被视为实验组（第1组），而在戈里齐亚由同一乳房治疗团队按照标准化最佳实践规则但未使用预防方案治疗的患者被视为对照组（第2组）。第一组有5例感染患者（1.7%），第二组有8例（7.9%），总体感染率为3.2%。
引入我们的预防方案后，我们发现使用植入物或组织扩张器的乳房手术后感染发生率较低。
