In cancer patients, breast implants increase infection frequency

Puneet Kollipara

A recent study by researchers at the Washington University School of Medicine found that female breast cancer patients who receive breast implants after mastectomies experience infections twice as frequently as women who have breast reconstruction using their own tissues.

According to Margaret Olsen, the lead author of the study and a research assistant professor of medicine, the study looked back at a group of women who had breast surgery other than breast conservation, or lumpectomy, between July 1, 1999 and June 30, 2002 at Barnes-Jewish Hospital. The study’s goal was to determine hospital costs due to surgical site infection.

The study found that surgical site infection brought an additional $4,091 in excess costs because of several variables, including the type of surgery, the amount of chemotherapy administered to the patient after surgery, age, weight, serious underlying diseases and years of surgery.

“We performed this study because it is important to determine costs of infection, in order for hospitals to perform cost-benefit analyses to compare the cost of interventions to prevent infection to the cost of the infections themselves,” said Olsen.

The researchers noticed that, of the breast cancer patients who experienced post-operative infections after breast reconstruction, twice as many of them had reconstructive surgery using implants as those using their own tissue.

However, Olsen warns that the study did not establish any independent association between increased risk of infection and the type of surgical procedure chosen because establishing such connections was not the study’s original goal.

“We did not do specific analyses to determine risk factors for infection in this study,” said Olsen. “We performed some simple univariate analyses to identify factors associated with surgical site infection, in order to determine the factors that needed to go into the multivariate models to determine attributable costs.”

The study also noted that non-cancer patients experienced a very low rate of infection following breast reduction and no infections after breast augmentation with implants.

“Women undergoing breast cancer surgery may have had preoperative chemotherapy, previous chest irradiation (if they had a recurrence of breast cancer), and may undergo post-operative chemotherapy or irradiation,” said Olsen.

In a Jan. 22 story in The New York Times, Keith Brandt, another author of the study and professor of plastic and reconstructive surgery at the School of Medicine, said that all patients receive prophylactic antibiotics at the time of the surgeries.

He also said that chemotherapy and irradiation tend to weaken the body’s immune system, making it more susceptible to infection.

Brandt could not be reached for further comment.

Additionally, Olsen said that breast reduction and cosmetic augmentation are typically performed in young, healthy women, while breast cancer surgeries are typically performed in older women, who may have afflictions, such as obesity or diabetes, associated with increased risk of infection.

“All of these factors are likely associated with increased risk of infection,” said Olsen. “Thus, it isn’t surprising that surgical site infection is more common following breast operations in women with breast cancer than after breast reduction or cosmetic augmentation.”

The researchers are now working on a study examining independent risk factors for post-operative infection using a logistic regression, a statistical model commonly used to establish the probability of certain events occurring.

Olsen advises women who want breast implants after mastectomies to discuss surgery options with their physicians and surgeons. Options include forgoing reconstruction, reconstruction with a breast implant and reconstruction using their own tissue, and some may choose to postpone reconstruction until a future date.

“Many factors go into this decision, including the overall health of the woman, body size, smoking history and personal desires,” said Olsen. “Women need to have very frank discussions with their surgeons to determine what is best for them, including discussions of the potential adverse events associated with the various operations, which includes the risk of infection.”

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