Variation in the use of infection control measures and infection-related revision incidence after breast implant surgery in the Netherlands

• Published in: JPRAS open 2022-12, Vol.34, p.226-238
• Main Authors: Becherer, Babette E., Marang-van de Mheen, Perla J., Young-Afat, Danny A., van der Hulst, Rene R.J.W., Keuter, Xavier H.A., Rakhorst, Hinne A., Mureau, Marc A.M.
• Format: Article
• Language: English
• Subjects: breast augmentation; breast implant surgery; breast reconstruction; infection control measures; infection-related revision surgery; Original
• ISSN: 2352-5878; 2352-5878
• DOI: 10.1016/j.jpra.2022.10.004

The use and effect of most infection control measures (ICMs) in breast implant surgery are still debated, likely resulting in undesired variation in current practices. This study investigated the relationship between the number and combinations of ICMs used and the infection-related revision incidence after breast implant surgery. Additionally, national variation between Dutch healthcare institutions in ICM-use was evaluated. For this multicentre, population-based study, all patients who received a primary breast implant or tissue expander for breast augmentation or reconstruction between 2015 and 2019 were identified in the Dutch Breast Implant Registry. Seven prospectively collected ICMs were investigated: preoperative antibiotics, implant and/or pocket irrigation, glove change, nipple guards, insertion sleeve, postoperative drains, and postoperative antibiotics. 52,415 implants were included (85% augmentation, 15% reconstruction). For augmentation, the median (IQR) number of ICMs used was three (3-4), for reconstruction four (4-5). Median follow-up was 30 months (augmentation) and 34 months (reconstruction). Infection-related revision incidence was 0.1% (augmentation) and 2.1% (reconstruction). Most infection-related revisions occurred within 2 months (augmentation) and 2.5 months (reconstruction). The impact of ICM-use on infection-related revision incidence remained unclear, given its low incidence. Between institutions, most variation was observed for the use of postoperative antibiotics and drains. Although the use of different ICMs varied considerably between institutions, infection-related revision incidence after breast implant surgery was generally low. Most surgeons used 4 ICMs for breast reconstruction and 3 ICMs for breast augmentation. Further exploration of the reasons for and impact of the observed variation is needed.