Breast reconstruction with implants: Reducing the Risk of Infection

Rebuilding breasts after mastectomy can be done with your own fatty tissue, but most often, about 80% of the time, it’s done with breast implants.

Although breast implants aren’t permanent, and they don’t feel as natural as your own tissue, they do have advantages over reconstruction with autologous tissue flaps: surgery is less invasive and shorter, and recovery is easier.

One common problem with any prosthetic device placed in the body, including breast implants, is infection. Not all women with implants develop infection, but many do. Some implant-related infections are more easily treated than others. In all cases, antibiotics—sometimes prolonged use—are required. Depending on the extent and  severity of the infection and its response to treatment, debriding the wound and other actions may be necessary, including hospitalization, additional surgery, and removing the implants--additional surgery to replace the implants isn’t done until the infection is healed. Women who have repeated implant-related infections sometimes do better when they convert to tissue flap reconstruction.

Drs. Adrian Ooi (Singapore General Hospital) and David Song (University of Chicago Medicine and Biological Sciences) recently published a summary of the newest literature on infections related to breast reconstruction with implants. Based on their analysis, they identified conditions that put women at most risk for infections after breast implant reconstruction, and recommended actions:

• Smoking (no smoking at least 2 weeks before reconstructive surgery)
• Hypertension (control with medication before surgery)
• Diabetes mellitus (control blood sugar levels before surgery)
• Compromised immune system (consider tissue flap unless white count can be stabilized)
• Larger breast size (recommend tissue flap or reduced breast size)

The authors recommend tissue flap over breast implant reconstruction for women who:

• are older than age 50
  
• are obese (BMI >30)
  
• have had prior radiation
  
• have adjuvant chemotherapy
  

They also recommend a separate, pre-mastectomy procedure to remove axillary lymph nodes, if necessary (rather than dissecting the nodes at the time of mastectomy). For patients who are at high risk for infection, they also recommend delayed, rather than immediate breast reconstruction, which tends to result in higher rates of infection.

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Resource: Adrian SH Ooi and David H Song. “Reducing infection risk in implant-based breast-reconstruction surgery: challenges and solutions.” Breast Cancer-Targets and Therapy. September 1, 2016.