Skip to main content

Advertisement

SpringerLink
Log in

Body mass index impacts infection rates in immediate autogenous breast reconstruction

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Risk of postoperative infection following breast cancer reconstruction warrants consideration of both classic and procedure-specific risk factors. We performed a retrospective chart review of patients with breast cancer over a 10-year period that underwent reconstructive surgery to identify factors that increase risk of postoperative infection.

Methods

Rates of postoperative infection were assessed in primary (immediate or delayed, alloplastic or autogenous) and secondary reconstructive procedures. Patient characteristics, surgical details, and cancer features were analyzed using two-sample t test and Fisher’s exact test for continuous and categorical data, respectively.

Results

456 procedures were performed on 264 patients with 29 cases of postoperative infection (6%). Infection was more likely to occur in earlier reconstructive procedures (p < 0.03). Overall, primary reconstructive procedures were associated with a higher infection rate (p = 0.005). Other associated risk factors included: autogenous reconstruction (p < 0.018), length of admission (p < 0.001) and immediate reconstruction (p = 0.01). Subgroup analysis revealed increased risk of infection with immediate autogenous reconstruction (p < 0.03). Furthermore, patients with greater body mass index (BMI) receiving immediate autogenous reconstruction had a greater risk of infection (p < 0.003). Factors unrelated to risk of infection included history of irradiation, smoking, cancer stage, tumor type and tumor size.

Conclusions

Our findings suggest that risk of infection is higher in immediate autogenous reconstructions particularly when patients are overweight (BMI > 30). Our data do not support a relationship between infection and irradiation, features of cancer, or repeated reconstructive procedures. Prospective studies may be required to further validate these findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Baxter N, Goel V, Semple JL (2005) Utilization and regional variation of breast reconstruction in Canada. Plast Reconstr Surg 115(1):338–339

    CAS  PubMed  Google Scholar 

  2. Barnsley GP, Sigurdson L, Kirkland S (2008) Barriers to breast reconstruction after mastectomy in Nova Scotia. Can J Surg 51(6):447–452

    PubMed  PubMed Central  Google Scholar 

  3. Gieni M, Avram R, Dickson L et al (2012) Local breast cancer recurrence after mastectomy and immediate breast reconstruction for invasive cancer: a meta-analysis. Breast 21(3):230–236

    Article  CAS  PubMed  Google Scholar 

  4. Platt J, Baxter NN, McLaughlin J, Semple JL (2015) Does breast reconstruction after mastectomy for breast cancer affect overall survival? Long-term follow-up of a retrospective population-based cohort. Plast Reconstr Surg 135(3):468e–476e

    Article  CAS  PubMed  Google Scholar 

  5. Morrow M, Li Y, Alderman AK et al (2014) Access to breast reconstruction after mastectomy and patient perspectives on reconstruction decision making. JAMA Surg 149(10):1015

    Article  PubMed  PubMed Central  Google Scholar 

  6. Platt J, Baxter N, Zhong T (2011) Breast reconstruction after mastectomy for breast cancer. CMAJ 183(18):2109–2116

    Article  PubMed  PubMed Central  Google Scholar 

  7. Platt J, Zhong T, Moineddin R et al (2015) Geographic variation immediate and delayed breast reconstruction utilization in Ontario, Canada and plastic surgeon availability: a population-based observational study. World J Surg 39(8):1909–1921

    Article  PubMed  Google Scholar 

  8. Gabriel SE, Woods JE, O’Fallon WM, Beard CM, Kurland LT, Melton LJ (1997) Complications leading to surgery after breast implantation. N Engl J Med 336(10):677–682

    Article  CAS  PubMed  Google Scholar 

  9. Olsen MA, Lefta M, Dietz JR et al (2008) Risk factors for surgical site infection after major breast operation. J Am Coll Surg 207(3):326–335

    Article  PubMed  PubMed Central  Google Scholar 

  10. Nelson JA, Chung CU, Fischer JP, Kanchwala SK, Serletti JM, Wu LC (2015) Wound healing complications after autologous breast reconstruction: a model to predict risk. J Plast Reconstr Aesthet Surg 68(4):531–539

    Article  PubMed  Google Scholar 

  11. Huo J, Smith BD, Giordano SH, Reece GP, Shih YCT (2016) Post-mastectomy breast reconstruction and its subsequent complications: a comparison between obese and non-obese women with breast cancer. Breast Cancer Res Treat 157(2):373–383

    Article  PubMed  Google Scholar 

  12. Francis SH, Ruberg RL, Stevenson KB et al (2009) Independent risk factors for infection in tissue expander breast reconstruction. Plast Reconstr Surg 124(6):1790–1796

    Article  CAS  PubMed  Google Scholar 

  13. Armstrong RW, Berkowitz RL, Bolding F (1989) Infection following breast reconstruction. Ann Plast Surg 23(4):284–288

    Article  CAS  PubMed  Google Scholar 

  14. Lefebvre D, Penel N, Deberles MF, Fournier C (2000) Incidence and surgical wound infection risk factors in breast cancer surgery. Press Med. 29(35):1927–1932

    CAS  Google Scholar 

  15. Mortenson MM, Schneider PD, Khatri VP et al (2004) Immediate breast reconstruction after mastectomy increases wound complications: however, initiation of adjuvant chemotherapy is not delayed. Arch Surg 139(9):988–991

    Article  PubMed  Google Scholar 

  16. Costerton JW, Montanaro L, Arciola CR (2005) Biofilm in implant infections: its production and regulation. Int J Artif Organs 28:1062–1068

    Article  CAS  PubMed  Google Scholar 

  17. Costa MA, Rommer E, Peric M et al (2013) Incidence of surgical-site infection is not affected by method of immediate breast reconstruction. Plast Reconstr Surg. 132(1):20e–29e

    Article  CAS  PubMed  Google Scholar 

  18. Ilonzo N, Tsang A, Tsantes S, Estabrook A, Thu Ma AM (2017) Breast reconstruction after mastectomy: a ten-year analysis of trends and immediate postoperative outcomes. Breast 32:7–12

    Article  PubMed  Google Scholar 

  19. Bertin ML, Crowe J, Gordon SM (1998) Determinants of surgical site infection after breast surgery. Am J Infect Control 26(1):61–65

    Article  CAS  PubMed  Google Scholar 

  20. Vilar-Compte D, Jacquemin B, Robles-Vidal C, Volkow P (2004) Surgical site infections in breast surgery: case–control study. World J Surg 28(3):242–246

    Article  PubMed  Google Scholar 

  21. Vilar-Compte D, Rosales S, Hernandez-Mello N, Maafs E, Volkow P (2009) Surveillance, control, and prevention of surgical site infections in breast cancer surgery: a 5-year experience. Am J Infect Control 37(8):674–679

    Article  PubMed  Google Scholar 

  22. Tong W, Baumann D, Villa M et al (2016) Obese women experience fewer complications after oncoplastic breast repair following partial mastectomy than after immediate total breast reconstruction. Plast Reconstr Surg 137(3):777–791

    Article  CAS  PubMed  Google Scholar 

  23. Pinsolle V, Grinfeder C, Mathoulin-Pelissier S, Faucher A (2006) Complications analysis of 266 immediate breast reconstructions. J Plast Reconstr Aesthetic Surg. 59(10):1017–1024

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada

    Lauren I. Willoughby

  2. Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, 149 College Street, 5th Floor, Suite 508, Toronto, ON, M5T 1P5, Canada

    Josephine A. D’Abbondanza, Healther L. Baltzer, James L. Mahoney & Melinda A. Musgrave

Authors
  1. Lauren I. Willoughby
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Josephine A. D’Abbondanza
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Healther L. Baltzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James L. Mahoney
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Melinda A. Musgrave
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Josephine A. D’Abbondanza.

Ethics declarations

Conflict of interest

Lauren I. Whilloughby, MD, FRCS(C), Josephine A. D’Abbondanza, MD, MSc declares , Heather L. Baltzer, MD, MSc, FRCS(C), James L. Mahoney, MD, FRCS(C), and Melinda A. Musgrave, MD, PhD, FRCS(C) declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, informed consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Willoughby, L.I., D’Abbondanza, J.A., Baltzer, H.L. et al. Body mass index impacts infection rates in immediate autogenous breast reconstruction. Breast Cancer Res Treat 175, 765–773 (2019). https://doi.org/10.1007/s10549-019-05215-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-019-05215-x

Keywords

Search

Navigation