A large-volume academic center retrospective audit of the temporal evolution of immediate breast reconstruction protocols and the effect on breast prosthetic infection

Background: Complications of tissue expanders (TEs) in breast reconstruction are challenging. We sought to identify TE infection risks and acellular dermal matrix (ADM) and infection control protocol impacts on infection in a longitudinal study. Methods: We retrospectively analyzed TE/implant reconstructions in 2004 (no ADM), 2009 (TE and ADM), 2013 (TE, ADM, and infection control protocol), and 2015 (TE, ADM, and infection control protocol). We assessed demographic, disease, and operative factors and analyzed rates of seroma, hematoma, skin necrosis, and infection. Statistical analysis, including simple and multivariable logistic regression, was performed using Stata v13.1. Results: 478 TEs were placed in 324 women, with a 30% overall patient complication rate (23% of breasts). A total of 14% of TEs became infected. Although unadjusted analysis showed no ADM and infection association (p = 0.269), multivariable logistic regression showed a significant association with more infections (OR: 3.21; 95% CI: 1.13-9.313; p = 0.029). The infection control protocol decreased infections by 28% (16% in 2009 vs 11% in 2013); however, this did not achieve statistical significance (unadjusted p = 0.192, adjusted p = 0.156). Seroma (p < 0.001), older age (p = 0.040), larger mastectomy volume (p = 0.001), smoking (p = 0.037), BMI (p < 0.001), vascular disorders (p = 0.007), and hypertension (p < 0.001) significantly increased infections. Conclusions: Identifiable risks exist in TE/implant breast reconstruction. ADM infection risk may mitigate some potential benefits. Anti-infection protocols may reduce infections, and further investigation may reveal the most effective prophylactic strategies. Absence of major changes in complications over time supports validity of studies examining large numbers of despite evolution of techniques. (C) 2018 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.