Does Incision Type Impact Culture Positivity in Implant-Based Reconstruction Complications for Breast Cancer and Breast Cancer Prophylaxis?

Background: Implant-based reconstruction (IBR) is the most common method of breast reconstruction after mastectomy. Prior studies have demonstrated that complications rates vary with incision type. We evaluated whether incision type affected culture positivity in IBR complications. Methods: A retrospective cohort study was performed of all patients undergoing mastectomy for cancer or cancer prophylaxis with IBR from 2012 to 2023. Abstracted data included patient characteristics, oncologic treatment history, mastectomy and reconstruction characteristics, culture positivity, infectious organism, and antibiotic treatment history. Results: A total of 6901 patients underwent post-mastectomy implant-based reconstruction, 183 (2.7%) patients had unplanned operative intervention for IBR complications, and 80/183 (43.7%) had culture-positive IBR infections. Culture-negative and culture-positive groups were similar in patient characteristics and oncologic treatment history. There was no difference in mastectomy incision types. The most common organisms were methicillin-sensitive Staphylococcus aureus, Pseudomonas aeruginosa, and coagulase-negative Staphylococcus. More patients in the culture-positive group were treated with antibiotics (81.2% vs. 51.5%, p = 0.0005). Antibiotic therapy duration was longer in the culture-negative group (8.52 vs. 5.78 days, p = 0.039). Among different incision types, there was no significant difference in duration of antibiotic therapy. Conclusions: No association between mastectomy incision type and culture-positive infections was observed among IBR complications in this study. Antibiotics may sterilize cultures, but operative intervention is still often required for IBR infections.