Studying Peri-Prosthetic Breast Fluid: Can We Prevent Implant Infections?
Jaime L. Bernstein*1, Anna M. Vaeth2, Karina Condez2, Kristen Castellano2, Grant G. Black2, David Otterburn2
1NewYork Presbyterian-Cornell/Columbia, New York, NY; 2Surgery, Weill Cornell Medicine, New York, NY
80% percent of breast reconstructions following mastectomy are implant based. Infection is a major source of morbidity of this procedure, with rates as high as 35%. Early detection of implant infection prior to clinical symptoms could decrease implant loss. Our current method of breast reconstruction is drainless with a dual chamber tissue expander (TE) in the pre-pectoral plane. With this TE, fluid is drained in a sterile fashion routinely in the post-operative period, allowing us to study the peri-prosthetic fluid as it relates to infection, for which currently little to no data exists on.
This is a prospective study of patients undergoing mastectomy and pre-pectoral, drainless, TE reconstruction. The peri-prosthetic fluid was collected through the TE drainage port in the operating room immediately after closure, at 1 week post op, and 3 weeks post op. This fluid was studied for microorganisms through traditional culture and next generation sequencing (NGS). Patients were observed for clinical infection and their need for antibiotics, return to OR, or implant loss was recorded.
22 breasts (13 patients) were included in the study. Patients had a mean age of 49 and BMI of 25. The average length of drainage needed was 21 days post-operative, with a mean of 131 cc of fluid drained per breast per week. Microorganisms were detected in 4 breasts in the immediate post-operative sample, 3 clearing by 1 week post op and the 4th clearing by 3 weeks post op. During the study, there were no clinical implant infections and no return to the operating room or implant loss.
Although this is a pilot study, we have shown that overall, we are able to achieve sterility of the breast pocket in a pre-pectoral TE reconstruction and maintain sterility with subsequent percutaneous punctures for drainage. In the 4 breasts where bacteria were present in the immediate post-operative period, clinical infection was avoided with antibiotics. Detection of peri-prosthetic microorganisms before they become clinically symptomatic could significantly decrease the rate of implant infection and loss.
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