Nelson Jonas A, Vingan Perri S, Graziano Francis D, Mandelbaum Max, Rochlin Danielle, Boe Lillian A, Gutierrez Julia, Matros Evan, Mehrara Babak J, Coriddi Michelle R
From the Plastic and Reconstructive Surgery Service, Department of Surgery.
Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center.
Plast Reconstr Surg. 2025 Jun 1;155(6):961e-973e. doi: 10.1097/PRS.0000000000011809. Epub 2024 Oct 15.
Tissue expander (TE) infection is a critical postoperative complication in 2-stage implant-based breast reconstruction (IBBR). The authors assessed risk factors associated with TE infection and reconstructive loss and examined reconstructive salvage rates.
The authors retrospectively reviewed patients who underwent IBBR with TE placement from 2017 to 2022. Included were patients with TE infection treated with admission and intravenous antibiotics, interventional radiology (IR) drainage, and/or operative management (washout with or without TE removal and TE replacement, TE removal and replacement with implant, and/or TE removal without replacement). Reconstructive success was defined as maintenance of breast reconstruction for 1 year after TE placement.
Of 4498 patients who underwent IBBR, 305 (338 TEs) met the inclusion criteria. Cox modeling showed that higher body mass index, hypertension, radiation therapy, bilateral TEs, acellular dermal matrix use, increasing mastectomy weight, and nipple-sparing mastectomy were associated with increased hazard of TE infection. Patients with TE infection had a 54% reconstructive failure rate within 1 year; Cox modeling showed that Black race and Gram-negative cultures were associated with increased hazard of reconstructive failure within 1 year. Patients who underwent TE replacement with an implant had the most favorable success rate following infection.
Overall, 46% of patients admitted with a periprosthetic infection had successful salvage. Patients with TE infection should be started on intravenous antibiotics with a low threshold for operative intervention based on examination and culture data. Although IR can guide operative intervention of periprosthetic infections, our practice has shifted away from IR drainage toward definitive operative management.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
组织扩张器（TE）感染是两阶段植入式乳房重建（IBBR）术后的一种严重并发症。作者评估了与TE感染和重建失败相关的风险因素，并检查了重建挽救率。
作者回顾性分析了2017年至2022年接受TE植入的IBBR患者。纳入的患者包括接受住院和静脉抗生素治疗、介入放射学（IR）引流和/或手术治疗（冲洗并保留或移除TE及更换TE、移除TE并植入假体、和/或移除TE不进行更换）的TE感染患者。重建成功定义为TE植入后乳房重建维持1年。
在4498例接受IBBR的患者中，305例（338个TE）符合纳入标准。Cox模型显示，较高的体重指数、高血压、放疗、双侧TE、使用脱细胞真皮基质、乳房切除术重量增加和保乳手术与TE感染风险增加相关。TE感染患者1年内重建失败率为54%；Cox模型显示，黑人种族和革兰氏阴性菌培养与1年内重建失败风险增加相关。感染后接受TE更换为假体的患者成功率最高。
总体而言，46%因假体周围感染入院的患者挽救成功。对于TE感染患者，应根据检查和培养数据，低阈值启动静脉抗生素治疗，并进行手术干预。虽然IR可指导假体周围感染的手术干预，但我们的做法已从IR引流转向确定性手术治疗。
临床问题/证据水平：风险，III级。
