Abstract: Radiation and Chemotherapy Not Associated with Infection following Breast Reconstruction: A Single-Institution Retrospective Study
Year: 2016
Type: conference-abstract
Abstract: PURPOSE: Infections may complicate breast reconstruction and factors found to predict infection vary between authors, with smoking, radiation, and chemotherapy frequently cited. 1–4 The authors aimed to evaluate factors associated with infections. METHODS: Patients undergoing breast reconstruction since 2003 with follow up in our institution’s medical record system were reviewed. Chi-squared and independent t-tests were used to identify variables associated with infection; associated variables (p<0.05) were used to build a logistic regression. RESULTS: Four hundred thirty-three patients were included, of whom 88 had infections (20.3%). Twenty-three patients had superficial infections, fifty-four had deep infections, and 11 developed both. Infection was more common among patients undergoing implant reconstruction (OR 2.65, 1.50–4.70). Seventy-one implant reconstruction patients (25.2% of all implant-based reconstruction) developed an infection versus 17 autologous reconstruction patients (11.3% of all autologous reconstructions). On univariate analysis, patients who developed infections had more co-morbidities (1.2 ± 1.2 versus 0.92 ± 1.3, p=0.042). They were more likely to be Caucasian (OR 1.69, 1.05–2.71), to be current smokers (OR 2.50, 1.20–5.19), to have undergone implant reconstruction (OR 2.65, 1.50–4.70), to have received radiation (OR 1.76, 1.09–2.85) or to have received chemotherapy (OR 1.62, 1.00–261). Patients with infections were also more likely to have had a dehiscence (OR 2.27, 1.35–3.81), seroma (OR 1.99, 1.11–3.55), or implant exposure (OR 9.79, 3.61–26.60). Factors found to be significant on univariate analysis were entered together into a multivariate regression. Results showed that implant exposure increased odds of infection by 165% (p=0.003), implant-based reconstruction increased them by 90.6% (p=0.004), and dehiscence increased these odds by 65.1% (p=0.034). Patients with infections were more likely to decline further reconstructive procedures (OR 2.10, 1.21–3.64) and require more procedures overall (5.08 ± 2.35 versus 3.74 ± 1.75, p<0.0001), largely driven by more implant exchanges (1.89 ± 1.74 versus 1.29 ± 1.13, p=0.017). Infected patients were not any less likely to finish their reconstructions, as indicated by nipple reconstruction or tattooing (OR 0.90, 0.58–1.49). CONCLUSIONS: Contrary to previous studies, we did not find that radiotherapy or chemotherapy were associated with infection in a regression model. While it was reassuring to find that infected patients were not less likely to complete breast reconstruction, the increased number of procedures these patients undergo is concerning from a cost and risk-exposure standpoint. REFERENCES: 1 Reish RG, Damjanovic B, Austen WG Jr et al. Infection following implant-based reconstruction in 19542 consecutive breast reconstruction: Salvage rates and predictors of success. Plast Reconstr Surg. 2013; 131:1223–30. doi: 10.1097/PRS.0b013e31828bd377 2 Adkinson JM, Miller NF, Eid SM, Miles MG, Murphy RX. Tissue expander complications predict permanent implant complications and failure of breast reconstruction. Ann Plast Surg. 2015; 75: 24–8. doi: 10.1097/SAP.0000000000000142 3 Wang F, Peled AW, Chin R et al. The impact of radiation therapy, lymph node dissection, and hormonal therapy on outcomes of tissue expander-implant exchange in prosthetic breast reconstruction. Plast Reconstr Surg. 2016;137. doi:10:1097/PRS.0000000000001866. 4 Sbitany H, Wang F, Peled AW, et al. Immediate implant-based breast reconstruction following total skin-sparing mastectomy: Defining the risk of preoperative and postoperative radiation therapy for surgical outcomes. Plast Reconstr Surg. 2014;134:396–404. doi: 10.1097/PRS.0000000000000466.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,195
OpenAlex ID: W2523317248