BACKGROUND Tissue expander (TE) infection requiring explantation is an unfortunate complication of implant-based breast reconstruction. Although several studies have analyzed risk factors for tissue expander removal prior to permanent implant placement in breast reconstruction, the outcome following explantation because of infection is unknown. This study analyzes the outcome of patients who have had an infected TE removed, in an effort to determine which patients are candidates for secondary prosthetic reconstruction.

METHODS Using a prospectively maintained database, patients who underwent removal of an infected TE over a 10-year period at a single institution were identified, and subsequent reconstructive procedures noted. A retrospective chart review was then performed recording patient characteristics that might affect outcome, reasons for reconstruction vs. none, and final outcome.

RESULTS From June 1994 to November 2004, 3,181 TE's were placed in 2,539 patients. Thirty-nine (1.2%) TE's were removed due to infection, a mean of 56 days after insertion. Twelve (30.8%) patients had received prior x-ray therapy (XRT). Nine patients (23%) underwent secondary reconstruction with another TE, 3 (7.7%) with a latissimus dorsi flap and TE, and one (2.6%) with a free transverse rectus abdominis flap (Fig. 1). Recurrent infection requiring explantation occurred in one patient who underwent re-expansion. Two patients developed late contractures. All other secondary prosthetic reconstructions were successful. Only two radiated patients underwent secondary reconstruction. Twenty-six patients (66.7%) did not undergo later reconstruction, most commonly due to a combination of patient preference, cancer progression, and XRT exposure.

CONCLUSIONS After removal of an infected TE, most patients who are interested and remain good candidates can still be reconstructed. Of the patients who underwent secondary reconstruction, 69% could be re-expanded. Re-expansion was successful in patients who had not received XRT. When there is a history of XRT exposure, secondary reconstruction with autologous tissue is appropriate.