The Breast Journal | 2019
The effect of surgical site infection in immediate breast reconstruction on breast cancer recurrence
Abstract
Breast cancer is the most common tumor diagnosed in women. Survival rates following a diagnosis of breast cancer have improved significantly due to advances in screening and treatment. According to the National Institute for Health and Clinical Excellence in the UK, breast reconstruction should be available to all women undergoing a mastectomy. IBR (Immediate breast reconstruction) after mastectomy impacts on the patient’s psychological well‐being, sexuality, and femininity. Breast reconstruction rates postmastectomy have increased, particularly immediate breast reconstruction. However, recent controversy has arisen surrounding the oncological safety of immediate reconstruction. In particular, it has been suggested that an associated wound infection may confer a detrimental survival outcome. There are a substantial number of studies examining the oncological safety of different methods of reconstruction, but the evidence with regard to postoperative wound infections and it’s effect on recurrence is limited. Our study aim was to compare recurrence, disease‐free survival, and time to recurrence and overall survival after IBR with postoperative wound complication. A retrospective review of breast cancer patients who underwent immediate breast reconstruction at our center from January 2008 to May 2017 was performed. The primary outcomes evaluated were the incidence of surgical site infection, disease‐free survival, and overall survival. Recurrence was defined as the presence of local recurrence or distant metastasis. Wound complications included the following: infection, hematoma, skin necrosis (±split‐thickness skin graft STSG), and implant removal. Infection was defined as per the Centers for Disease Control and Prevention/National Healthcare Safety Network guidelines. All collected data were analyzed with Statistical Package for Social Sciences (SPSS) version 23 (Dublin, Ireland). A P value <0.05 was considered statistically significant. A total of 163 patients underwent IBR between January 2008 and May 2017. 107 were included in the study and 56 were excluded (Table 1). Sentinel node biopsy was performed in 99.1% (n = 106) and axillary node clearance in 43% (n = 46; Table 2). After a median follow‐up of 47 months (range 3‐111), local‐regional recurrence occurred in three cases, two cases occurring within the same year of initial diagnosis. Distant metastatic disease occurred in five patients (bone (n = 4), liver (n = 1). Of these eight women who had disease recurrence, two subsequently died. A total of 26 (23.3%) patients had a postoperative complication (Table 3). Of these, 19 (17.8%) were infection related implant removed ± abscess (n = 4), cellulitis (n = 5), skin necrosis (n = 1), hematoma (n = 2), skin necrosis + STSG (n = 4), cellulitis + positive peripheral blood cultures (n = 1), and purulent discharge (n = 2). Of those who had infection six were DIEP (deep inferior epigastric perforators), six were latissimus dorsi only, six implant only, and one transverse upper gracilis flap. Ten patients with an infection underwent axillary node clearance. There was no association between infection and axillary node