Study Says Implants Double Risk of Infection in Breast Reconstruction

By NATASHA SINGER
Breast cancer patients who had reconstructive surgery using implants immediately after mastectomies were twice as likely to acquire infections as women who immediately had breast reconstruction using their own tissue, according to a study published yesterday.
The article in Archives of Surgery, which examined the medical records of breast surgery patients at Barnes-Jewish Hospital in St. Louis from mid-1999 to mid-2002, found that 50 of 949 patients acquired an infection at the surgical site within a year after surgery.
Roughly 12 percent of the infections occurred in mastectomy patients who immediately had implant surgery, compared with roughly 6 percent of infections in those who immediately had breast reconstruction using their own abdominal tissue, the study said. In noncancer patients, about 1 percent of infections occurred after breast reductions and no infections occurred after breast augmentation using implants, the study said.
“The bottom line is that implants are associated with an increased risk of infection in breast cancer patients,” said Margaret A. Olsen, the lead author of the study and a research assistant professor of medicine at Washington University School of Medicine in St. Louis. “The question is what factors contribute to this increased risk and what can be done to prevent it?”
The study noted whether patients had other medical conditions like diabetes, but it did not report how many underwent radiation or other treatments that might have played a role in the infections.
The study did analyze the cost to the medical center of each infection — about $4,100 per patient — a hospital-acquired complication not covered by managed care, she said.
But both kinds of reconstructive surgery entail risk.
Dr. Stephen R. Colen, the chairman of plastic and reconstructive surgery at Hackensack University Medical Center in New Jersey, said operations using abdominal tissue took several hours longer than implant surgery, increasing the risk of blood clots and lung embolisms. In 2 percent of patients, the transplanted tissue dies, requiring further surgery, Dr. Colen said.
But implant reconstruction inserts a foreign object into the body, providing a surface on which bacteria may grow. And implantation involves a series of procedures — including one surgery to insert a skin-stretching device in the chest, followed by saline injections to expand the breast, another surgery to put in a permanent implant and a final surgery to attach a nipple — creating more occasions for infection to occur, Dr. Colen said.
Dr. Keith E. Brandt, a professor of plastic and reconstructive surgery at Washington University and an author of the study, said all patients received prophylactic antibiotics at the time of surgery. But postsurgical treatments for breast cancer, like radiation, may weaken the body’s ability to fight infection.

Physicians may be obstacles to breast reconstruction

Significant differences in plastic surgery referral practices by general surgeons treating newly diagnosed breast cancer patients partially explain the low rates of breast reconstructive surgery in the United States, according to a new study. Published in the May 1, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study suggests that only one quarter of general surgeons refer most breast cancer patients for a reconstruction consultation at the time of treatment planning.
Despite the fact that insurance covers the procedure, only 16 percent of breast cancer patients treated with a mastectomy receive breast reconstruction in the US. Studies have shown that age and race predict low rates of this reconstructive procedure. However, studies also suggest that healthcare providers have an impact on utilization through their referral and information sharing practices.