Abstract
Background: Prevention of infection and capsular contracture remains a primary goal of implant-based breast reconstruction (IBBR). Previous studies have demonstrated improved outcomes with the use of triple-antibiotic solution (TAS) for breast pocket irrigation, but ready-to-use products have recently gained popularity. The purpose of this study is to compare outcomes following IBBR between TAS and low-concentration chlorhexidine gluconate (CHG) solutions. Methods: This is a retrospective analysis of 690 consecutive patients undergoing IBBR from 2008-2017. The TAS (n = 346) irrigation solution was composed of 1 g cefazolin, 80 mg gentamicin and 50,000 U bacitracin diluted in 500 mL of normal saline; the CHG (n = 344) irrigation solution was the commercially-available product Irrisept (0.05% chlorhexidine gluconate in sterile water, Irrimax Corporation, Lawrenceville, GA). Comparisons were made between demographic and clinical variables. Complications were recorded and statistical analysis, including multivariate regression analysis, was performed. Results: The TAS group underwent significantly more skin-sparing mastectomies, adjuvant chemotherapy/radiation and less direct-to-implant reconstruction than the CHG group. The CHG group experienced a significantly lower incidence of total complications (22.4% vs. 31.8%, p = 0.006), minor complications (8.7% vs. 16.5%, p = 0.003), infection (6.4% vs. 12.7%, p = 0.006) and seroma (2.6% vs. 6.9%, p = 0.011). There was a significantly increased rate of delayed wound healing in the CHG group. Multivariate analysis showed that the use of CHG solution significantly decreased the odds of any complication by 1.6-fold (OR 0.637, 95% CI 0.414 - 0.977) and the odds of infection by 2.4-fold (OR 0.420, 95% CI 0.218 - 0.809). There were no statistically significant differences in rates of capsular contracture or other complications. Conclusions: The use of CHG as a pocket irrigant in post-mastectomy breast reconstruction is a reasonable alternative to other solutions, in efforts to minimize prosthetic based complications.
Highlights
Significant advances in breast cancer screening and management over the past thirty years have led to marked improvements in survivability after diagnosis and quality of life following oncologic treatment
The triple-antibiotic solution (TAS) (n = 346) irrigation solution was composed of 1 g cefazolin, 80 mg gentamicin and 50,000 U bacitracin diluted in 500 mL of normal saline; the CHG (n = 344) irrigation solution was the commercially-available product Irrisept® (0.05% chlorhexidine gluconate in sterile water, Irrimax Corporation, Lawrenceville, GA)
The purpose of this study is to investigate the difference in outcomes following implant-based breast reconstruction (IBBR) using triple-antibiotic (TAS) versus low-concentration chlorhexidine gluconate (CHG) solutions
Summary
Significant advances in breast cancer screening and management over the past thirty years have led to marked improvements in survivability after diagnosis and quality of life following oncologic treatment. There has been a marked increase in the number of patients seeking breast reconstruction, demonstrated by a 62% increase in the rate of reconstructive procedures after mastectomy from 2009-2014 in one study [2]. According to a recent report of 67,450 patients undergoing mastectomy for breast cancer from 2005-2014, the percentage of patients undergoing reconstruction has increased from 26.94% in 2005 to 43.30% in 2014, with a significant increase in the use of TE-based implantation from 15.54% to 33.30% [4]. Previous studies have demonstrated improved outcomes with the use of triple-antibiotic solution (TAS) for breast pocket irrigation, but ready-to-use products have recently gained popularity. There was a significantly increased rate of delayed wound healing in the CHG group
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