Decreasing expander breast infection: A new drain care protocol

Abstract

Background: Risk factors for expander reconstruction infection are well known. However, drain use as a risk factor for the development of infection is unclear.

Objective: To review a simple method for drain use to help reduce rates of infection in expander breast reconstruction.

Methods: Two hundred consecutive single-surgeon (JDM) immediate first-stage expander breast reconstructions were retrospectively reviewed. The records were reviewed for history and physical examination, intra-operative technique, perioperative management, adjuvant therapy, and outcome with respect to expander infection necessitating premature explantation within the first eight weeks. Infection was defined on clinical basis, with or without culture positivity. All expanders (Mentor, USA) were the same model (textured, port-integrated and biodimensional). Two consecutive series of reconstructions were then created. The first series included 177 reconstructions while the second series included 23 reconstructions. Unlike the first series, the second series introduced a protocol in which all reconstructions received mupirocin 2% cream to the drain sites and all drains were removed at the end of the first week. Additionally, in the second series, all expanders were secluded from direct in vivo contact with the closed suction drain either by the use of an intervening Alloderm sling (LifeCell Corporation, USA, 15 of 23 breasts) or by subdermally tunnelling the drain superficial to an adequate fatty subcutaneous layer (eight of 23 breasts).

Results: Patients who developed infection in the first series and all patients in the second series shared statistically the same level of aggregate risk factors (P=0.531). The infection rate (5.65%, 10 infections in 177 breasts) in the first series was statistically greater than in the second series (0%, 0 in 23 breasts, P=0.001).

Conclusions: The present study found that percutaneous closed suction drains do serve as an increased risk for expander infection. However, early results indicate that in vivo protection of the expander with Alloderm or subdermal tunnelling, topical antibiotic ointment use and early drain removal may significantly reduce expander infection.

Keywords: Adult; Alloderm; Breast expander; Breast implants; Breast neoplasms; Breast reconstruction; Closed suction drains; Combined modality therapy; Drains; Female; Humans; Infection; Mammaplasty; Mastectomy; Mupirocin; Tissue expansion devices.

Figures

Figure 1)

Subdermal tunnelling of drain (cross section)

Figure 2)

Drain draped over Alloderm (LifeCell Corporation, USA) and pectoralis major muscle.