INTRODUCTION: One of the most devastating complications after prosthetic breast reconstruction is infection. In the literature the infection rate of breast reconstruction using an implant device after mastectomy ranges between 1 to 35%.1,2 Antibiotic treatment is the most conservative management but has inconsistent results: successful salvage without removal or exchange of the device ranges from 0 to 25%.3 Currently, there are no detailed guidelines for antibiotics or protocol for the type of antibiotic, duration of treatment, or route of administration.
PURPOSE: The primary aim of this study was to determine the effectiveness of a combination antibiotic protocol to treat breast prosthetic infections in mastectomy patients. Secondary aims included the identification of risk factors in patients who failed antibiotic salvage.
METHODS: A protocol for all breast implant infections was instituted. Patients with clinical signs of infection were placed on intravenous piperacillin/tazobactam and daptomycin for 3 weeks. If patients did not respond or had progression of infection then the prosthetic device was removed. A single institution retrospective chart review evaluated procedures completed from 1/1/2014 to 5/15/2015 at Roswell Park Cancer Institute.
RESULTS: Nineteen mastectomies followed by breast prosthetic reconstruction were identified in the study. The mean surgical age was 48.7 years (SD +/- 9.2). Of the nineteen procedures, 9 had sentinel node biopsies and 1 underwent axillary node dissection. Subgroup analysis reveals majority of procedures resulting in a breast infection were patients who were current or previous smokers and either overweight or obese. Mean days to infection from surgery date were 29.0 days. The majority of the patients, 84.2% (16/19), had complete resolution of the infection. Patients without resolution of their infection, 15.8% (3/19) had their prosthetic devices removed. Mean and median duration of follow-up was 327.6 days (SD 78.28) and 332 days (range 196–493), respectively.
CONCLUSION: Implementation of a standardized antibiotic protocol of piperacillin/tazobactam and daptomycin resulted in a prosthetic device salvage rate of 84% in post mastectomy patients. This result is the highest salvage in post mastectomy patients. The early institution of an antibiotic protocol as conservative management for treatment of breast implant infections was effective in this cohort of patients.
Reference Citations:
1. ASh O, Song DH. Reducing infection risk in implant-based breast-reconstruction surgery: challenges and solutions. Breast cancer (Dove Medical Press) JID - 101591856 PMC - PMC5012596 OID - NLM: PMC5012596 OTO - NOTNLM. 0913.
2. Reish RG, Damjanovic B FAU - Austen, William G.,Jr, Austen WG Jr FAU - Winograd, Jonathan, Winograd J FAU - Liao, Eric,C., FAU LE, FAU CC, et al. Infection following implant-based reconstruction in 1952 consecutive breast reconstructions: salvage rates and predictors of success. Plastic and reconstructive surgery JID - 1306050. 0802.
3. Spear SL, FAU HM, FAU BJ, Ducic IF, Low M FAU - Abbruzzesse, Mark, R., Abbruzzesse MR. The infected or exposed breast implant: management and treatment strategies. Plastic and reconstructive surgery JID - 1306050. 0525.