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Expander/Implant Removal After Breast Reconstruction: Analysis of Risk Factors and Timeline

  • Original Article
  • Breast Surgery
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

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

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Author information

Authors and Affiliations

  1. Department of Head, Neck and Plastic Surgery, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA

    Cemile Nurdan Ozturk, Can Ozturk, Allison Soucise, Mary Platek, Robert Lohman & Wong Moon

  2. Department of Health, Nutrition and Dietetics, Buffalo State College, Buffalo, NY, USA

    Mary Platek

  3. Jacobs School of Medicine, State University of New York, Buffalo, NY, USA

    Nabiha Ahsan

  4. Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA

    Risal Djohan

Authors
  1. Cemile Nurdan Ozturk
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  2. Can Ozturk
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Correspondence to Cemile Nurdan Ozturk.

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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

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