Characterizing infections in prosthetic breast reconstruction: A validity assessment of national health databases

Merisa L. Piper, Lauren O. Roussel, Peter F. Koltz, Frederick Wang, Kyra Singh, Robin Chin, Hani Sbitany, Howard N. Langstein

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


Introduction Current guidelines in the United States require reporting only the 30-day postoperative outcomes to standardized databases, including the National Surgical Quality Improvement Program (NSQIP). Thus, many breast implant-related complications go unreported in standard databases. We sought to characterize late periprosthetic infections following implant-based breast reconstruction. Methods We conducted a retrospective analysis of all women who underwent expander/implant reconstruction from 2005 to 2014 at two institutions. All periprosthetic infections were identified and divided into early and late cohorts (≤30 days or >30 days). Infection was defined as any episode where antibiotics were initiated or a prosthetic device was explanted because of clinical evidence of the infection. Results In the 1820 patients (2980 breasts) identified, 421 periprosthetic infections occurred (14%). Of these, 173 (41%) were early and 248 (59%) were late (mean time to infection = 66.4 ± 101.9 days). Patients with late infections were more likely to be current smokers or have diabetes than patients with early infections (p < 0.034 for both). Infections caused by gram-negative bacteria and antimicrobial-resistant strains of Staphylococcus were more common in the early infection group (p < 0.001 for both). Implant loss due to infection was more common in the late infection group (p = 0.037). Discussion Late periprosthetic infections following implant-based breast reconstruction are underestimated in national outcome databases and have unique risk factors and microbiology compared to early infections. A system-level change in reevaluating and redefining a timeline for tracking and treating implant infections is necessary, given the substantial morbidity associated with, and frequency of, late periprosthetic infections.

Original languageEnglish
Pages (from-to)1345-1353
Number of pages9
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Issue number10
StatePublished - 1 Oct 2017
Externally publishedYes


  • Breast implant
  • Breast reconstruction
  • Expander implant
  • Implant-based breast reconstruction
  • Late infection
  • Periprosthetic infection


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