2023, Vol. 27 ›› Issue (3): 461-469

Use of expanders and implants in breast reconstruction complicated with infection

Wang Kaiyu, Hu Peng, Wei Zairong, Huang Guangtao, Zhou Jian, He Guijia, Nie Kaiyu   

Abstract: BACKGROUND: With the improvement of women’s aesthetic and therapeutic needs, breast reconstruction has become a commonly used treatment option after breast cancer surgery, of which the use of expanders and implants is high. Infection, as the most common complication with the use of expanders and implants, can lead to a range of consequences and even affect the results of breast reconstruction. With the deep understanding of the risk factors leading to infection in breast reconstruction, the continuous improvement of treatment options and the application of new materials, the occurrence of infection can be reduced and the success rate of breast reconstruction can be improved.
OBJECTIVE: To summarize the risk factors, prevention and treatment measures of infection associated with the use of expanders and implants in breast reconstruction, and to introduce the application prospects of new materials in breast reconstruction.
METHODS: Related articles were retrieved on CNKI, Wanfang, PubMed, and Web of Science databases. Search terms were “tissue expander, breast implants, breast reconstruction, infection” in Chinese and English. According to the inclusion and exclusion criteria, after preliminary screening of articles, 119 articles with high relevance and reference value were reviewed.
RESULTS AND CONCLUSION: (1) Breast reconstruction based on tissue expanders and implants is widely used in clinical practice, and multiple risk factors may lead to the occurrence of infection after breast reconstruction and, in severe cases, to the loss of expanders and implants. (2) Breast reconstruction expanders and implants are subdivided into multiple types according to different material characteristics, of which the roughness of surface is an important cause affecting the occurrence of infection. Although the smooth surface has a higher incidence of seroma than the textured surface, drainage is usually taken in advance to avoid the risk of infection caused by seroma in clinical practice. (3) Clinicians need to carefully evaluate the probability of infection and reasonably select expanders or implants in combination with the health status and treatment methods of breast reconstruction patients. For example, for patients with multiple preoperative infection factors, the selection of smooth surface expanders or implants may be more conducive to the prevention and control of infection. (4) Second-generation cephalosporins can be used to prevent infection after reconstruction, and can be used in combination with quinolones when necessary. For patients who have shown signs of infection, it is necessary to timely select bacteria-sensitive antibiotics for treatment according to bacterial culture and drug sensitivity test, and preserve expanders or implants for patients as far as possible. (5) At present, some studies have developed new breast reconstruction materials and drug coatings. Because such products have their own advantages of antibacterial and inhibition of bacterial attachment, they can fundamentally reduce the incidence of expander and implant infection and have shown positive therapeutic effect in some clinical case studies. However, further randomized controlled trials with large samples are needed to verify it in the future.
Key words: mammaplasty, breast reconstruction, tissue expansion device, breast implant, infection, risk factor, therapy, acellular dermal matrix