Timing Matters: Risk Factors And Outcomes Of Late Tissue Expander Infections
Year: 2026
Type: conference-paper
Study design: Observational Study
Abstract: PURPOSE: Tissue expander (TE) reconstruction is common after mastectomy, yet infectious complications remain a significant challenge. Reported postoperative infection rates range from 2.5-3.4%, but most studies focus only on the immediate 30-day period. Late tissue expander (TE) infectionsoccurring beyond 30 daysare underreported despite their potential to disrupt reconstruction, delay oncologic therapy, and necessitate explantation. This study aimed to describe the incidence of late infections (>30 days) and to identify clinical and operative risk factors for infection between early (≤30 days) and late (>30 days) infections. METHODS: We performed a retrospective chart review of patients who underwent tissue expander (TE)-based breast reconstruction between January 2018 and May 2025. Inclusion criteria required ≥3 months of follow-up and completion of the reconstructive journey (expander to definitive reconstruction). Collected demographic variables included age, sex, BMI, race/ethnicity, smoking history, and diabetes status. Surgical variables included mastectomy type, lymph node surgery, mastectomy specimen weight, TE pocket location (prepectoral vs. subpectoral), and acellular dermal matrix use. Postoperative outcomes included hematoma, seroma, wound dehiscence, surgical debridement, and infection. For infected cases, infection timing (≤30 vs. >30 days), management strategy, antibiotic use, culture results, and downstream reconstructive outcomes were recorded. Univariate logistic regression models were used to identify variables associated with infection and multivariate regression was used to determine independent predictors after adjusting for confounding factors. RESULTS: A total of 1,169 breasts from 722 patients were identified. Overall, 142 breasts (12.1%) developed an infection. 107 infections (75%) occurred late (>30 days) and 35 (25%) occurred early (≤30 days). The mean time to infection was 61 days after TE placement. On multivariate analysis after controlling for BMI, diabetes, smoking status, radiotherapy, chemotherapy, ADM use, TE plan placement, and mastectomy weight, only history of axillary dissection was associated with an increased risk for TE infection (21.9% vs. 11.7%, p=0.003). After controlling for the same confounders, early infections were found to be associated with ADM use (60% vs. 40%, p=0.020). CONCLUSION: Most TE infections occur outside the conventional 30-day postoperative period. A history of axillary dissection was associated with postoperative infection and early infections were associated with ADM use. These findings suggest that the conventional 30-day window is not an adequate quality measure when examining TE outcomes.© 2026. Plastic Surgery Research Council | All rights reserved |*Source: https://ps-rc.org/meeting/Program/2026/AS103.cgi*
Institution: University of Utah
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7160668584