# A Multi-Center Retrospective Observational Analysis of Three-Year Experience of Our Protocol for Prevention and Monitoring of Surgical Site Infections in Implant-Based Breast Reconstruction

## TL;DR

A study found that a prevention protocol reduced implant infection rates in breast reconstruction surgery by comparing two hospitals.

## Contribution

The study evaluates a novel prevention protocol for reducing surgical site infections in implant-based breast reconstruction.

## Key findings

- The infection rate was 1.7% in the hospital using the prevention protocol versus 7.9% without it.
- The overall infection rate across both groups was 3.2%.
- The protocol led to fewer postoperative infections and better outcomes.

## Abstract

With the increase in the mastectomy rate, the number of patients opting for postmastectomy reconstruction has been rising, with implant-based procedures being the most commonly used method. One of the most feared complications is the loss of reconstruction, often caused by implant infection. This can lead to prolonged antibiotic treatments, additional surgical procedures, capsular contracture, and unsatisfactory aesthetic results, with a significant psychological impact on patients. This study analyzed infection rates at our institution and evaluated the effectiveness of our prevention protocol introduced in 2020, comparing the data on surgical site infections (SSIs) between Trieste Hospital (with the protocol) and another center in Gorizia (without the protocol). We enrolled 396 patients, divided into the experimental group (Trieste) and the control group (Gorizia). Infected patients were 5 in the first group (1.7%) and 8 in the second group (7.9%), with an overall infection rate of 3.2%. We conclude that the prevention protocol has reduced the incidence of postoperative infections.

Background: With the rise in the mastectomy rate, the number of patients who choose to undergo postmastectomy reconstruction has been increasing, and implant-based procedures are the most performed methods for postmastectomy breast reconstruction. Among the possible complications, the most feared is the loss of reconstruction. It can be related to several reasons, but one of the most common is infection of the implant, which can lead to prolonged antibiotic treatment, undesired additional surgical procedures, increased incidence of capsular contracture, and unsatisfactory aesthetics results, with a huge psychological impact on patients. Aims: The primary intent of this study is to analyze the status of infection rates at our institution and evaluate the effectiveness of our prevention protocol since its introduction. Secondly, we compared data of the surgical site infections (SSIs) after implant-based breast reconstruction at Trieste Hospital, where the protocol has been employed since 2020, and in another center, where plastic surgeons of our team are involved, with different prevention procedures. Methods and Results: We enrolled 396 female patients, who underwent implant-based breast reconstruction, using definitive mammary implants or breast tissue expanders, with or without ADM (acellular dermal matrix), both for breast cancer and risk-reducing surgery in BRCA1/2 patients. Patients treated at the Hospital of Trieste, with the use of the prevention protocol, were considered the experimental group (group 1), while patients treated in Gorizia by the same breast team with standardized best-practice rules, but without the use of the prevention protocol, were considered the control group (group 2). Infected patients were 5 in the first group (1.7%) and 8 in the second one (7.9%), with a global infection rate of 3.2%. Conclusion: After the introduction of our prevention protocol, we faced a lower incidence of infection after breast surgery with implants or tissue expanders.