Abstract
Introduction
Removal of tissue expanders (TE) or implants is a dire consequence of breast reconstruction, and has the potential to halt the reconstructive efforts. Our goals were to characterize a cohort of patients with TE/implant removal, to perform a time-based analysis, and to review the bacteriology associated with explanted devices.
Materials and Methods
Review of a prospectively maintained database was performed to identify patients who underwent TE/implant removal. Patient characteristics, surgical technique, adjuvant therapies, indications, complications, culture results were obtained. Data were analyzed according to timing of explantation.
Results
A total of 55 TE and implants were removed in 43 patients. Reasons for explantation were infection (58%), patient request (22%), and wound-related complications (20%). The majority of explantations occurred after 30 days (62%), and after Stage I (81%). Median days to explantation was 62. Patients of older age (p = 0.01) and higher BMI (p = 0.02) were more likely to undergo explantation after Stage I. The most commonly cultured organisms were S. epidermidis (10.9%), S. aureus (10.9%) and P. aeruginosa (10.9%). Antibiotic resistance was commonly encountered for ampicillin, cefazolin, penicillin, and erythromycin.
Conclusion
Infection is the most common reason for explantation after prosthetic breast reconstruction. Patients should be carefully monitored for a prolonged period of time after Stage I, as the majority of explantations occur in this stage but beyond 30 days. For oral treatment, fluoroquinolones and trimethoprim–sulfamethoxazole and for IV treatment a combination of vancomycin or daptomycin with piperacillin–tazobactam or imipenems/carbapenems appear to be appropriate choices according to our culture results.
Level of Evidence IV
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Ozturk, C.N., Ozturk, C., Soucise, A. et al. Expander/Implant Removal After Breast Reconstruction: Analysis of Risk Factors and Timeline. Aesth Plast Surg 42, 64–72 (2018). https://doi.org/10.1007/s00266-017-1031-8
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DOI: https://doi.org/10.1007/s00266-017-1031-8