Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Immediate Implant Exchange during Acute Infection in the Setting of Breast Reconstruction
Russell E. Ettinger, MD, Shailesh Agarwal, MD, Theodore Kung, MD, David L. Brown, MD.
University of Michigan, Ann Arbor, MI, USA.

PURPOSE Acute prosthesis infection in the setting of breast reconstruction is traditionally managed with explantation and surgical washout followed by delayed replacement. However, this results in loss of the expanded breast, requiring re-expansion and placing significant psychological and physical burden on patients. In this study, we describe our experience managing breast implant infections with operative washout and immediate implant re-placement in breast reconstruction patients.
METHODS An Institutional Review Board-approved retrospective chart review was performed at the University of Michigan on all breast reconstruction patients who underwent surgical management for an infected breast implant by the senior surgeon (D.L.B.) from January 1, 2010 to December 31, 2013. Patients were included in the study if they were diagnosed with acute infection of the reconstructed breast and were taken to the operating room for washout and immediate exchange of either a tissue expander or permanent implant versus explantation. atient charts were reviewed for demographic information, implant type (expander versus permanent implant), whether the implant was immediately replaced at the time of washout, final reconstruction status, and time from washout to final reconstruction (months). Use of intravenous antibiotics, length of admission, additional interventions, and culture data were also collected.
RESULTS A total of 19 breast reconstruction patients with 20 breast expander/ permanent implant infections requiring operative intervention were identified during the study period. In each of these documented infections, the patient underwent removal of the infected implant. Immediate exchange of the implant was performed in eight patients (42%). Intraoperative cultures identified organisms in 13 (65%) infections. Intravenous antibiotics were started on seventeen patients and one patient was started on oral linezolid. All eight patients (100%) with immediate replacement of their implant went to have successful reconstruction; however, 75% (9/12) of infections which were not treated with immediate replacement went on to be fully reconstructed (p = 0.24). Mean time to final reconstruction among patients who had immediate replacement was 203 days, compared with 599 days in patients who did not have immediate replacement (p = 0.03).
CONCLUSIONS Here we describe our experience with immediate prosthesis exchange in breast reconstruction patients with infection. Our findings suggest that this technique is safe in appropriately selected patients. Furthermore, patients treated with immediate exchange have less time to final reconstruction.


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