A mastectomy is an emotional, life-changing ordeal. An infection and subsequent delay in reconstructive surgery decreases a patient’s quality of life by delaying recovery and the resumption of pre-surgical activities. The highest risk for TE-related infections occurs at the time of surgery and while the drain remains in place allowing portals for microbial colonization (about two weeks post-operatively).

Infection Post-Mastectomy

  • The rate of infection post-mastectomy with the use of a tissue expander (TE) is 2.4 to 24%. Estimated mean is 12-14%*.
  • Once an implant becomes infected, the patient requires increased hospitalization and approximately 2 weeks of IV and/or oral antimicrobials. The TE is removed, leading to a possible delay of lifesaving chemo or radiation therapy, along with a more complex reconstruction in the future.

The preventive measures used to decrease the rate of TE infections are:

a) systemic perioperative antimicrobial agents;

b) perioperative immersion of the implant or irrigation of the surgical pocket with an antimicrobial solution prior to insertion of the device; or

c) immediate postoperative oral antimicrobials.

Except for (a), all of the other preventive modalities are of debatable use.

Illustration of breast cancer

Armstrong RW. Ann Plast Surg 1989;23:284-8
Francis SH. Plast Reconstr Surg 2009;124:1790-6
Rosenblatt et al. 2015. Novel in situ liquefying antimicrobial wrap for preventing tissue expander infections following breast reconstructive surgeries. J Biomed Mater Res Part B 2015:00B.

*Please note that the 12-14% estimate for mean infection rates is an estimate from clinicians and is not a published data point.