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Reducing infection risk in implant-based breast-reconstruction surgery: challenges and solutions

Authors Ooi ASH, Song DH

Received 1 June 2016

Accepted for publication 14 July 2016

Published 1 September 2016 Volume 2016:8 Pages 161—172

DOI https://doi.org/10.2147/BCTT.S97764

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 2

Editor who approved publication: Professor Pranela Rameshwar

Adrian SH Ooi,1,2 David H Song1

1Section of Plastic and Reconstructive Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA; 2Department of Plastic, Reconstructive, and Aesthetic Surgery, Singapore General Hospital, Singapore

Abstract: Implant-based procedures are the most commonly performed method for ­postmastectomy breast reconstruction. While donor-site morbidity is low, these procedures are associated with a higher risk of reconstructive loss. Many of these are related to infection of the implant, which can lead to prolonged antibiotic treatment, undesired additional surgical procedures, and unsatisfactory results. This review combines a summary of the recent literature regarding implant-related breast-reconstruction infections and combines this with a practical approach to the patient and surgery aimed at reducing this risk. Prevention of infection begins with appropriate reconstructive choice based on an assessment and optimization of risk factors. These include patient and disease characteristics, such as smoking, obesity, large breast size, and immediate reconstructive procedures, as well as adjuvant therapy, such as radiotherapy and chemotherapy. For implant-based breast reconstruction, preoperative planning and organization is key to reducing infection. A logical and consistent intraoperative and postoperative surgical protocol, including appropriate antibiotic choice, mastectomy-pocket creation, implant handling, and considered acellular dermal matrix use contribute toward the reduction of breast-implant infections.

Keywords: implant infection, risk reduction, acellular dermal matrix

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