Management of the Infected Tissue Expander

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.