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A Systematic Review Of Infection In Breast Reconstruction: Autologous Flap Vs. Implant Reconstruction
Brett T. Phillips, MD MBA, Svetlana Danovich, MD, Richa Verma, MD, Muath Bishawi, BS, Alexander B. Dagum, MD, Duc T. Bui, MD, Sami U. Khan, MD.
Stony Brook University Medical Center, Stony Brook, NY, USA.

Introduction: Infection rates have been noted to be as high as 35% in patients undergoing breast reconstruction with overall complication rates exceeding 52%. Recent literature supports an increased incidence of infectious complications associated with implant-based reconstruction with or without the use of acellular dermal matrix when compared to autologous reconstruction. The purpose of this study was to examine published infection rates in various forms of breast reconstruction.
Methods: Systematic electronic searches were performed in PubMed, OVID, and the Cochrane databases for studies that reported on infection in breast reconstruction patients. A combination of MeSH terms used in PubMed & OVID includes: Mammaplasty, Anti-Bacterial Agents, Breast Reconstruction, Antibiotics & Infection. Two authors reviewed studies between 1970 - 2011 for inclusion and data extraction. Articles had to document an infection rate in some form of breast reconstruction.
Results: A total of 995 studies were identified with an inclusion of 234 articles. A total of 39,406 breast reconstruction patients were included in this review with an average infection rate of 5.33% with a range from 0% to 35%. Patients were further grouped into implant, autologous, autologous/implant and combined reconstructions with a majority of articles addressing implant-based reconstruction. When comparing implant versus autologous-based reconstructions, there was no clinically significant difference between infection rates (5.28% vs. 4.70%). Autologous flap with implant reconstruction had a similar average infection rate of 5.46%, although it was reported less frequently in the literature. Due to variable outcome reporting and documentation, we were unable to further stratify patients based on reconstructive timing.
Conclusion: Popular opinion supports increased infections in implant reconstruction compared to autologous reconstruction. In a large systematic review of plastic surgery articles spanning over 40 years, we have found no clinically significant difference in infection rates between various forms of breast reconstruction.
Type of ReconstructionStudies
(n)*
Patients
(n)
Infection
(n)
Infection Rate
(%)
Implant1552293012115.28%
Autologous Flap79137526464.70%
Autologous Flap & Implant9403225.46%
Combined Reconstructions**2923212229.56%
Total3940621015.33%
*There were 54 studies that included more than one type of reconstruction. These studies
are broken down into type of reconstruction and added to their respective groups.
The total number of studies included in this analysis was 243.
**There were 29 studies in which multiple types of reconstructions were performed but
number of patients and/or infections could not be determined separately.


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