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Advances in Tissue Expander Technology Enables Microbial Monitoring of the Periprosthetic Space and Early Targeted Intervention in Prepectoral Breast Reconstruction
Farrah Liu, MD1, Dominic Henn, MD1,2, Kerry Shrefren, NP1, Derrick C. Wan, MD1, Arash Momeni, MD, FACS1 1 Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA 2 Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany

Background: Seroma and infection are among the most common complications after prepectoral breast reconstruction. Advances in tissue expander (TE) technology allow for seroma aspiration from the periprosthetic space via an integrated drain port, thus, holding promise for improving clinical outcomes.

Methods: A prospectively maintained database of patients who had undergone immediate prepectoral breast reconstruction with acellular dermal matrix and Sientra AlloX2 TE was used to analyze patient demographics, volume and microbial spectrum of aspirated periprosthetic fluid, as well as postoperative complications.

Results: 49 patients (mean age: 49 years, mean BMI: 24.5 kg/m2) underwent 79 prepectoral breast reconstructions, among which seroma was clinically suspected in 26 reconstructions (32.9%). Periprosthetic fluid was aspirated in clinic using the integrated TE drain port without image-guided intervention, enabling aspirations in 45 reconstructions (57%) without clinical evidence for seroma. Bacterial cultures from aspirated fluid were positive in 8 reconstructions (10.1%), from which only 3 reconstructions developed clinical infection. Routine fluid aspirations enabled treatment of a patient with prosthesis-associated Actinomycosis with targeted antibiotic therapy, eliminating the need for surgical revision.

Conclusion: Our study demonstrates that routine office-based aspiration of periprosthetic fluid via an integrated expander drain mitigate the need for ultrasound-guided fluid aspiration and allow for monitoring of the microbial spectrum of the periprosthetic space. This approach enables targeted antibiotic therapy without delay, thus, decreasing broad-spectrum antibiotic use and permitting device salvage without surgical intervention. Further, we show that positive bacterial cultures in the absence of clinical signs of infections do not mandate routine antibiotic therapy.

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