Reply: Late Surgical-Site Infection in Immediate Implant-Based Breast Reconstruction.

Abstract

Sir: We thank Caviggioli et al. for their interest in our study1 and comments. As noted by the authors, implant-based breast reconstruction remains the most popular method with which to address postmastectomy defects. The analysis of surgical-site infections, and, in particular, identifying risk factors for reconstruction failure, is essential to identifying proper reconstructive candidates and counseling patients appropriately. Although we agree with the authors that a single-center study can reduce the institutional variability, large prospective multicenter trials such as our study have the strength of identifying overall trends of reconstruction, reducing bias, and describing generally applicable outcomes. Comparing outcomes among a large number of plastic surgeons and individual institutions allows further refinement of outcome analysis and can provide a more accurate “real-world” measure compared with the retrospective single-center series that predominate in the literature. As described by Caviggioli et al., their preliminary results from the retrospective review of 477 implant-based breast reconstructions similarly found that the majority of surgical-site infections occur more than 30 days after the initial operation and confirm obesity as a predictor. Interestingly, however, the authors noted no increase in surgical-site infection with radiation therapy. This may indeed be attributable to their study population being limited to first-stage reconstructions at this time. The authors report adopting routine autologous fat grafting in the setting of postmastectomy radiotherapy to reduce pain and complications. Given the progressive soft-tissue fibrosis and vascular compromise inevitable with radiotherapy, the concept of fat grafting as a “regenerative procedure” is logical, and it would be interesting to see the authors’ follow-up results after completion of second-stage exchange procedures to evaluate its clinical impact. We thank Dr. Caviggioli et al. for their thoughtful comments and discussion. Understanding the nuances of implant-based breast reconstruction and complications based on practices at different institutions is crucial to refine decision-making regarding breast reconstruction and optimizing patient outcome. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Indranil Sinha, M.D.Yoon S. Chun, M.D.Division of Plastic SurgeryBrigham and Women’s HospitalBoston, Mass.