PURPOSE: The use of tissue expanders and subsequent placement of permanent breast implants has become an established technique to correct post-mastectomy deformities. Infection following placement of breast implants is a known complication that may create significant cost and anxiety for both patient and physician. Studies have been performed identifying risk factors for infection after placement of tissue expanders, but limited information exists about infections associated with placement of breast implants after tissue expansion. The goal of this study was to identify the risk factors associated with infectious complications after placement of permanent implants in the breast reconstruction patient. METHOD: Using a computerized patient database, patients were identified who had undergone previous tissue expansion and subsequent placement of a permanent prosthesis between January 2004 and January 2008. In addition to identifying patients who developed infectious complications, patient and implant characteristics were recorded. Statistical analysis was performed to identify risk factors that were associated with the development of infectious complications. RESULTS: Between January 2004 and January 2008, 117 breast implants were placed in 86 patients. Mean follow-up was 36.2 months. Six patients (6.9%) developed breast infections. Organisms isolated from these infections included Staphylococcus aureus (n=3) and Coagulase-negative Staphylococcus (n=1). These complications developed an average of 92.4 days (20 days to 216 days) following placement of permanent implants. Treatments for these patients included oral antibiotics (n=1), intravenous antibiotics (n=1), implant exchange with capsulectomy (n=2), and implant removal (n=2). When examining patient characteristics, higher body mass index (BMI) was associated with the development of infectious complications (34.3 vs. 26.5, p<0.05). Diabetic patients were also at increased risk of developing infections (Odds ratio 9.5, p<0.05). CONCLUSION: Tissue expander and implant reconstruction is a safe and reliable method of breast reconstruction. Our study indicates that a higher body mass index and a history of diabetes both appear to be risk factors for the development of infection. It was noted that infections can develop even several months after placement of the permanent implant. As a result, surgeons should aggressively treat patients with these risk factors whenever there exists a concern for infection.