Late Surgical-Site Infection in Immediate Implant-Based Breast Reconstruction
Bibliographic record
Abstract
Sir: Sinha and colleagues have recently published in Plastic and Reconstructive Surgery a very interesting prospective, multicenter cohort study about patients submitted to mastectomy and immediate implant-based reconstruction.1 A total of 11 centers in the United States and Canada contributed to this study. A total of 1662 implant-based breast reconstructions in 1024 patients were evaluated for early versus late surgical-site infections. We would like to congratulate the authors on their article, which systematically analyzes several factors to identify possible clinical predictors. We consider their work essential because implant-based breast reconstruction is currently the most popular method for breast reconstruction, and surgical-site infection is currently the major cause that leads to reconstructive failure. Large multicenter trials regarding patients submitted to immediate implant-based reconstruction are fundamental for identifying predictors of surgical-site infections and thus improving surgical-site infection clinical management and development of preventative measures. In our Breast Unit, we are performing a retrospective single-center trial on our population of patients submitted to immediate implant-based breast reconstruction. At present, we have evaluated a total of 477 first-stage breast reconstructions in 417 patients between March of 2013 and May of 2016. Different from the study by Sinha et al., which is multicenter, our work is a single-institution study, thus reducing variability in terms of surgical-site infection evaluation and treatment protocol, including the criteria for inpatient hospitalization and intravenous antibiotics, explantation versus salvage, and radiotherapy protocol. Our preliminary data confirm that the majority of surgical-site infection complications in immediate implant-based breast reconstructions occur more than 30 days after first-stage breast reconstruction (mean time of presentation, 51 ± 59.8 days) and present a total infection rate of 9.2 percent, comparable to that declared by Sinha et al. In addition, we confirm obesity as a major predictor for surgical-site infection, although, different from Sinha et al., we observe a strong statistical relation between increased age and the development of local infection. Differing from Sinha et al., we analyzed as a possible risk factor axillary dissection that could be related to delayed seroma without finding any relations with infection. In contrast, we did not observe any relation between radiotherapy and surgical-site infection. It should be emphasized that we consider only patients submitted to first-stage breast reconstruction and, as confirmed by Sinha et al., radiation therapy is identified as a significant independent risk factor for late surgical-site infection, particularly following a second-stage tissue expander exchange procedure. Nevertheless, moving from our long experience in adopting autologous fat graft in irradiated breasts to reduce pain syndrome,2–4 we developed a clinical protocol5 that widely adopts this regenerative procedure to reduce complications, obtaining a 5.6 percent reconstruction failure rate in patients submitted to immediate two-stage breast reconstruction followed by radiotherapy. In conclusion, we consider studies such as the one published by Sinha et al. essential to critically evaluate outcomes in implant-based breast reconstruction, finding possible clinical predictors for surgical infection, analyzing therapeutic protocols, and comparing the experience of different centers. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Fabio Caviggioli, M.D.Francesco Klinger, M.D.University of MilanReconstructive and Aesthetic Plastic Surgery SchoolMultiMedica Holding S.p.A.Plastic Surgery UnitSesto San Giovanni, Milan, Italy Andrea Lisa, M.D.Monica Vappiani, M.S.Valeriano Vinci, M.D.Marco Klinger, M.D.University of MilanReconstructive and Aesthetic Plastic Surgery SchoolDepartment of Medical Biotechnology and TranslationalMedicine BIOMETRAPlastic Surgery UnitHumanitas Research HospitalRozzano, Milan, Italy
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".