Defining Infection in Breast Reconstruction: A Literature Review.

Purpose: Postoperative infection is the most common complications after implant-based immediate breast reconstruction (IBR), with reported rates ranging from less than 1% to 43%. This heterogeneity among the literature may be explained by a lack of consensus on the definition of postoperative infection. The purpose of this study was to review the prevalence of infection and how it is defined in studies involving prosthetic-based IBR. It is necessary to establish a clear definition of infection to standardize the reporting of complications.

Methods: A comprehensive literature review was performed to identify infection rates among implant/tissue expander-based IBR performed between 1996 and 2017. A PubMed search using the keywords "immediate breast reconstruction" matched with "infection" and "tissue expanders" or "implant" was performed. Reconstructive modality, infection rates, and definitions were recorded and reviewed.

Results: An initial search provided 196 articles; 138 articles met inclusion criteria and were reviewed. Eighty-five (61%) articles failed to define infection and reported an infection rate ranging from 0% to 22%. The studies that characterized infection had highly variable definitions. Whereas some authors chose to define infection based on Centers for Disease Control guidelines, others used more subjective findings such as clinical signs of infection.

Conclusions: Currently, there is no consensus on the definition of infection after implant-based IBR. We propose that the definition should include the administration of antibiotics beyond the surgeon's standard perioperative period with or without the presence of localized clinical signs of infection (erythema, pain, increased temperature, etc). A universal definition of postoperative infection after implant-based IBR that accurately captures the incidence of infection will allow better comparisons between future studies.