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Breast Infections More Likely when Implants are used in Breast Reconstruction Surgery

Jan 23, 2008 | Parker Waichman LLP Breast implants can make breast reconstruction surgery more risky.  Researchers at the Washington University School of Medicine in St. Louis revealed that breast cancer patients undergoing reconstruction surgeries following mastectomy are twice as likely to suffer an infection at the surgery site if they receive an implant as opposed to their own tissue.  Researchers analyzed 949 hospital admissions for mastectomy or breast reconstruction surgery at a university-affiliated hospital between 1999 and 2002.

Reporting in the January issue of The Archives of Surgery, the researchers discovered that surgical site infections occurred in 50 women—or 5.3 percent—within one year of surgery. These infections arose in a little more than 12 percent of mastectomies where breast reconstruction involved an implant.  The figure was half—at six percent—of mastectomies where the reconstruction involved the patient's own abdominal tissue.  "The bottom line is that implants are associated with an increased risk of infection in breast cancer patients," study author Margaret Olsen, a research assistant professor of medicine at the university said adding, "The question is what factors contribute to this increased risk and what can be done to prevent it?"

The average time between surgery and infection diagnosis was about 47 days, the researchers found.  Also, patients with surgical site infections had significantly higher hospital cost, at about $4,100 per patient, as well as a longer total hospital stay lengths, the study authors wrote.

Another expert said there are many reasons why implants could boost infection risks.  Dr. Stephen R. Colen, chairman of plastic and reconstructive surgery at Hackensack University Medical Center in New Jersey, said whenever a foreign body is introduced during surgery it provides a vehicle on which bacteria can grow.  Colen also said that implantation involves a number of procedures that create opportunities for infections to occur.  Colen also stressed that reconstruction using abdominal tissue also comes with its own risks, saying that these procedures take several hours longer than implant reconstructions, which increases patients' risk for blood clots and lung embolisms.  In addition to the risks, transplanted tissue dies in two percent of the surgeries, thus necessitating additional surgery.

Effective prevention measures would reduce both infections and related costs, Olsen's team wrote, including "strategies to optimize the timing and dosage of prophylactic antibiotics administered before the surgical incision, glucose control in diabetic patients, promotion of meticulous hand hygiene, and strategies to promote timely removal of drains, among others."

Complications are possible in any surgical procedure, such as those related to the effects of anesthesia, infection, swelling, redness, bleeding, and pain.  Breast reconstruction also poses complications related to breast feeding—up to 64 percent of women with implants are unable to breast feed; pain as a result of improper implant size; changes in nipple and breast sensation, ranging from intense sensitivity to no feeling; extrusion, in which the implant breaks through the skin; implant deflation or rupture; seroma, in which fluid collects around the implant or incision; capsular contracuture, in which the scar tissue or capsule that normally forms around the implant tightens and squeezes the implant; necrosis, in which dead tissue forms around the implant; tissue atrophy; or chest wall deformity.

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