Closed Expander Salvage With Dual-port Tissue Expander in Implant-based Breast Reconstruction for High Body Mass Index and Ptotic Patients
Background:. Implant-based (IB) breast reconstruction is efficient and predictable but poses infection risks, especially in patients with high body mass index and/or macromastia. Postoperative infection management lacks standardized protocols for device salvage. Methods:. We conducted a 1-year retro...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2025-06-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006845 |
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| author | Alexander R. Gibstein, BA Aneeq S. Chaudhry, BA Rita Loureiro, PA-C Charo Thomas, BS Harry Salinas, MD Matthew Treiser, MD, PhD Miguel A. Medina, III, MD |
| author_facet | Alexander R. Gibstein, BA Aneeq S. Chaudhry, BA Rita Loureiro, PA-C Charo Thomas, BS Harry Salinas, MD Matthew Treiser, MD, PhD Miguel A. Medina, III, MD |
| author_sort | Alexander R. Gibstein, BA |
| collection | DOAJ |
| description | Background:. Implant-based (IB) breast reconstruction is efficient and predictable but poses infection risks, especially in patients with high body mass index and/or macromastia. Postoperative infection management lacks standardized protocols for device salvage.
Methods:. We conducted a 1-year retrospective study on 59 high-risk patients (91 breasts) using dual-port tissue expanders for breast reconstruction. A Wise-pattern skin envelope reduction closed over an inferiorly based adipodermal lining flap was used. Using the dual port, a closed washout protocol with a Betadine solution was initiated for suspected infections. Patient characteristics, infection profiles, and outcomes were recorded. A control cohort of 54 patients (98 breasts) without dual-port expanders was analyzed for infection rates and outcomes.
Results:. In the experimental cohort, 18% of breasts had postoperative infections, with 38% successfully salvaged using oral antibiotics and the closed washout alone. The overall salvage rate was 75%, and the infectious reconstructive failure rate was 3.3%. Gram-positive bacteria were predominant. The control cohort had a 23.5% infection rate, with only 5% successful salvage and 19 explantations. No statistically significant differences in demographics or infection rates were observed.
Conclusions:. The study demonstrated the efficacy of a closed wash protocol with dual-port tissue expanders in high-risk IB breast reconstruction. This approach reduces surgical washouts, improves salvage rates, and minimizes reconstruction losses. The dual-port expander shows promise in enhancing salvage outcomes and decreasing reoperations for postoperative infections, providing a valuable addition to IB breast reconstruction strategies. The results suggest potential benefits of the dual-port expander in infection treatment. |
| format | Article |
| id | doaj-art-8a6080db91d3424d8614ccf5392ce696 |
| institution | DOAJ |
| issn | 2169-7574 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj-art-8a6080db91d3424d8614ccf5392ce6962025-08-20T03:23:07ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742025-06-01136e684510.1097/GOX.0000000000006845202506000-00060Closed Expander Salvage With Dual-port Tissue Expander in Implant-based Breast Reconstruction for High Body Mass Index and Ptotic PatientsAlexander R. Gibstein, BA0Aneeq S. Chaudhry, BA1Rita Loureiro, PA-C2Charo Thomas, BS3Harry Salinas, MD4Matthew Treiser, MD, PhD5Miguel A. Medina, III, MD6From the * Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, FL† Division of Plastic and Reconstructive Surgery, Baptist Health South Florida, Miami Cancer Institute, Miami, FL.† Division of Plastic and Reconstructive Surgery, Baptist Health South Florida, Miami Cancer Institute, Miami, FL.† Division of Plastic and Reconstructive Surgery, Baptist Health South Florida, Miami Cancer Institute, Miami, FL.† Division of Plastic and Reconstructive Surgery, Baptist Health South Florida, Miami Cancer Institute, Miami, FL.† Division of Plastic and Reconstructive Surgery, Baptist Health South Florida, Miami Cancer Institute, Miami, FL.† Division of Plastic and Reconstructive Surgery, Baptist Health South Florida, Miami Cancer Institute, Miami, FL.Background:. Implant-based (IB) breast reconstruction is efficient and predictable but poses infection risks, especially in patients with high body mass index and/or macromastia. Postoperative infection management lacks standardized protocols for device salvage. Methods:. We conducted a 1-year retrospective study on 59 high-risk patients (91 breasts) using dual-port tissue expanders for breast reconstruction. A Wise-pattern skin envelope reduction closed over an inferiorly based adipodermal lining flap was used. Using the dual port, a closed washout protocol with a Betadine solution was initiated for suspected infections. Patient characteristics, infection profiles, and outcomes were recorded. A control cohort of 54 patients (98 breasts) without dual-port expanders was analyzed for infection rates and outcomes. Results:. In the experimental cohort, 18% of breasts had postoperative infections, with 38% successfully salvaged using oral antibiotics and the closed washout alone. The overall salvage rate was 75%, and the infectious reconstructive failure rate was 3.3%. Gram-positive bacteria were predominant. The control cohort had a 23.5% infection rate, with only 5% successful salvage and 19 explantations. No statistically significant differences in demographics or infection rates were observed. Conclusions:. The study demonstrated the efficacy of a closed wash protocol with dual-port tissue expanders in high-risk IB breast reconstruction. This approach reduces surgical washouts, improves salvage rates, and minimizes reconstruction losses. The dual-port expander shows promise in enhancing salvage outcomes and decreasing reoperations for postoperative infections, providing a valuable addition to IB breast reconstruction strategies. The results suggest potential benefits of the dual-port expander in infection treatment.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006845 |
| spellingShingle | Alexander R. Gibstein, BA Aneeq S. Chaudhry, BA Rita Loureiro, PA-C Charo Thomas, BS Harry Salinas, MD Matthew Treiser, MD, PhD Miguel A. Medina, III, MD Closed Expander Salvage With Dual-port Tissue Expander in Implant-based Breast Reconstruction for High Body Mass Index and Ptotic Patients Plastic and Reconstructive Surgery, Global Open |
| title | Closed Expander Salvage With Dual-port Tissue Expander in Implant-based Breast Reconstruction for High Body Mass Index and Ptotic Patients |
| title_full | Closed Expander Salvage With Dual-port Tissue Expander in Implant-based Breast Reconstruction for High Body Mass Index and Ptotic Patients |
| title_fullStr | Closed Expander Salvage With Dual-port Tissue Expander in Implant-based Breast Reconstruction for High Body Mass Index and Ptotic Patients |
| title_full_unstemmed | Closed Expander Salvage With Dual-port Tissue Expander in Implant-based Breast Reconstruction for High Body Mass Index and Ptotic Patients |
| title_short | Closed Expander Salvage With Dual-port Tissue Expander in Implant-based Breast Reconstruction for High Body Mass Index and Ptotic Patients |
| title_sort | closed expander salvage with dual port tissue expander in implant based breast reconstruction for high body mass index and ptotic patients |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006845 |
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