Immediate Implant-based Breast Reconstruction with Acellular Dermal Matrix Compared with Tissue-expander Breast Reconstruction: Rate of Infection
Background:. The risk of infection continues to be a subject of discussion within the field of implant-based breast reconstruction. Studies have shown the feasibility of immediate single-stage procedures with acellular dermal matrix (ADM), yet 2-stage tissue expander techniques continue to be the pr...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2018-12-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000001949 |
| _version_ | 1819091874874392576 |
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| author | Marcello Carminati, MD Darja Sempf, BS Pier Paolo Bonfirraro, MD Luca Devalle, MD Maurizio Verga, MD Bernardo Righi, MD Gabriele Mevio, MD Francesco Leone, MD Privato Fenaroli, MD Enrico Robotti, MD |
| author_facet | Marcello Carminati, MD Darja Sempf, BS Pier Paolo Bonfirraro, MD Luca Devalle, MD Maurizio Verga, MD Bernardo Righi, MD Gabriele Mevio, MD Francesco Leone, MD Privato Fenaroli, MD Enrico Robotti, MD |
| author_sort | Marcello Carminati, MD |
| collection | DOAJ |
| description | Background:. The risk of infection continues to be a subject of discussion within the field of implant-based breast reconstruction. Studies have shown the feasibility of immediate single-stage procedures with acellular dermal matrix (ADM), yet 2-stage tissue expander techniques continue to be the procedure most often performed. The purpose of this study was to evaluate postoperative infections and to identify associated predictors.
Methods:. A retrospective study at Papa Giovanni XXIII Hospital was conducted between 2013 and 2017. Patients’ demographic data were compared between single-stage and 2-stage procedures. Rate of infection and predictors were examined. Minor infections could be treated by oral antibiotics only, major infections required inpatient treatment. Healing was considered a successful treatment with antibiotics only, whereas any supplementary surgical intervention resulting in the preservation of an implant device was considered salvage. Breast reconstruction was defined a failure in case of implant loss or need for autologous reconstruction.
Results:. Three hundred ninety-three patients underwent 336 monolateral and 57 bilateral implant-based breast reconstruction. Ninety-two patients had a submuscular direct-to-implant reconstruction with ADM with an infection rate of 11.4% compared with an infection rate of 7.8% among the 268 patients with a 2-stage tissue expander procedure. Beta-binomial regression showed obesity and preoperative radiotherapy as significant predictors for infection (OR, 4.65, P = 0.038, and OR, 7.13, P = 0.015, respectively). Average time of onset of infection among the submuscular direct-to-implant with ADM group was 67.1 days compared with 80.1 days among tissue-expander group with postoperative chemotherapy and preoperative radiotherapy having a significant effect on time of infection onset (P = 0.014, P = 0.034, respectively).
Conclusions:. Direct-to-implant breast reconstruction with ADM is a procedure with acceptable risks of infection in comparison to tissue expander procedures. A profound patient selection pre- and intraoperatively is the basis of successful breast reconstruction. |
| first_indexed | 2024-12-21T22:46:40Z |
| format | Article |
| id | doaj.art-f1da5f5cc6624014acc2adfb1352b8ab |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-12-21T22:46:40Z |
| publishDate | 2018-12-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-f1da5f5cc6624014acc2adfb1352b8ab2022-12-21T18:47:42ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742018-12-01612e194910.1097/GOX.0000000000001949201812000-00004Immediate Implant-based Breast Reconstruction with Acellular Dermal Matrix Compared with Tissue-expander Breast Reconstruction: Rate of InfectionMarcello Carminati, MD0Darja Sempf, BS1Pier Paolo Bonfirraro, MD2Luca Devalle, MD3Maurizio Verga, MD4Bernardo Righi, MD5Gabriele Mevio, MD6Francesco Leone, MD7Privato Fenaroli, MD8Enrico Robotti, MD9From the * Plastic and Reconstructive Surgery Unit, ASST Papa Giovanni XXIII, Bergamo, Italy† Faculty of Health, Medicine & Life Sciences, Maastricht University, The NetherlandsFrom the * Plastic and Reconstructive Surgery Unit, ASST Papa Giovanni XXIII, Bergamo, ItalyFrom the * Plastic and Reconstructive Surgery Unit, ASST Papa Giovanni XXIII, Bergamo, ItalyFrom the * Plastic and Reconstructive Surgery Unit, ASST Papa Giovanni XXIII, Bergamo, ItalyFrom the * Plastic and Reconstructive Surgery Unit, ASST Papa Giovanni XXIII, Bergamo, ItalyFrom the * Plastic and Reconstructive Surgery Unit, ASST Papa Giovanni XXIII, Bergamo, ItalyFrom the * Plastic and Reconstructive Surgery Unit, ASST Papa Giovanni XXIII, Bergamo, Italy‡ Breast Surgery Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.From the * Plastic and Reconstructive Surgery Unit, ASST Papa Giovanni XXIII, Bergamo, ItalyBackground:. The risk of infection continues to be a subject of discussion within the field of implant-based breast reconstruction. Studies have shown the feasibility of immediate single-stage procedures with acellular dermal matrix (ADM), yet 2-stage tissue expander techniques continue to be the procedure most often performed. The purpose of this study was to evaluate postoperative infections and to identify associated predictors. Methods:. A retrospective study at Papa Giovanni XXIII Hospital was conducted between 2013 and 2017. Patients’ demographic data were compared between single-stage and 2-stage procedures. Rate of infection and predictors were examined. Minor infections could be treated by oral antibiotics only, major infections required inpatient treatment. Healing was considered a successful treatment with antibiotics only, whereas any supplementary surgical intervention resulting in the preservation of an implant device was considered salvage. Breast reconstruction was defined a failure in case of implant loss or need for autologous reconstruction. Results:. Three hundred ninety-three patients underwent 336 monolateral and 57 bilateral implant-based breast reconstruction. Ninety-two patients had a submuscular direct-to-implant reconstruction with ADM with an infection rate of 11.4% compared with an infection rate of 7.8% among the 268 patients with a 2-stage tissue expander procedure. Beta-binomial regression showed obesity and preoperative radiotherapy as significant predictors for infection (OR, 4.65, P = 0.038, and OR, 7.13, P = 0.015, respectively). Average time of onset of infection among the submuscular direct-to-implant with ADM group was 67.1 days compared with 80.1 days among tissue-expander group with postoperative chemotherapy and preoperative radiotherapy having a significant effect on time of infection onset (P = 0.014, P = 0.034, respectively). Conclusions:. Direct-to-implant breast reconstruction with ADM is a procedure with acceptable risks of infection in comparison to tissue expander procedures. A profound patient selection pre- and intraoperatively is the basis of successful breast reconstruction.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000001949 |
| spellingShingle | Marcello Carminati, MD Darja Sempf, BS Pier Paolo Bonfirraro, MD Luca Devalle, MD Maurizio Verga, MD Bernardo Righi, MD Gabriele Mevio, MD Francesco Leone, MD Privato Fenaroli, MD Enrico Robotti, MD Immediate Implant-based Breast Reconstruction with Acellular Dermal Matrix Compared with Tissue-expander Breast Reconstruction: Rate of Infection Plastic and Reconstructive Surgery, Global Open |
| title | Immediate Implant-based Breast Reconstruction with Acellular Dermal Matrix Compared with Tissue-expander Breast Reconstruction: Rate of Infection |
| title_full | Immediate Implant-based Breast Reconstruction with Acellular Dermal Matrix Compared with Tissue-expander Breast Reconstruction: Rate of Infection |
| title_fullStr | Immediate Implant-based Breast Reconstruction with Acellular Dermal Matrix Compared with Tissue-expander Breast Reconstruction: Rate of Infection |
| title_full_unstemmed | Immediate Implant-based Breast Reconstruction with Acellular Dermal Matrix Compared with Tissue-expander Breast Reconstruction: Rate of Infection |
| title_short | Immediate Implant-based Breast Reconstruction with Acellular Dermal Matrix Compared with Tissue-expander Breast Reconstruction: Rate of Infection |
| title_sort | immediate implant based breast reconstruction with acellular dermal matrix compared with tissue expander breast reconstruction rate of infection |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000001949 |
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