Preface

With the changing face of breast surgery, surgical site infections (SSIs) continue to be an important concern that impacts patient outcomes, recovery times, and quality of care. The complexity of the surgical procedures- and the diversity of patients we take care of- are increasing, and so the knowledge of the SSIs and how to prevent them is essential for healthcare professionals.

This book aims to be a significant reference on the subject, with both the basic and practical information attentively compiled for the breast surgeon.

Part I of this book begins with the definition of the subject of surgical site infections, in order to provide a clear understanding of its implications and significance in breast surgery. We discuss the anatomy of the breast and the important structures that are directly relevant to surgery and risk of infection. Following this basic knowledge, the clinical and physio-pathological aspects of breast infections are also reviewed. Furthermore, a presentation of the various clinical presentations and the specific problems of breast cancer surgery will be provided.

Antiseptic treatments, including surgical drains and skin preparation techniques, are also discussed, as they are key components of effective prevention in infections. We also discuss the consequences of SSIs, the use of negative wound therapy and specific issues regarding breast implants and tissue expanders. Another important matter elaborated in the book is the association of SSIs with other morbidities and, also, the description of complications at the donor site after autologous breast reconstruction, thus emphasising the complex challenges faced by surgeons on a daily basis.

Knowing the risk factors and predictors in breast surgery is essential for informed decision-making. We emphasise the nuances of these factors, including the impact of COVID-19 and the challenges in low- to middle-income countries where resources may be scarce but the need for effective management is pressing.

The end of Part I of the book (the theoretical part) includes a strong discussion of strategies to manage infection and continues with the final conclusions. The reader is afterwards “equipped” with key points from the main aspects of the book, and a quiz further tests the information discussed throughout the book.

Part II of the book focuses on the practical aspects of diagnosis and management of breast infections and aims to give readers insight into the experience and knowledge that can be very useful in their clinical practice. The book is supplemented with visual aids such as tables, diagrams and photographs to help in understanding and remembering the facts that are presented.

The contents of this book are not only conducive to a revision of the available data on the subject of surgical site infections in breast surgery, but also to the engagement and critical thinking of our readers.

This material is aimed at: surgeons, healthcare professionals and researchers who are committed to the advancement of breast surgery and patient care. We hope that this volume of information will offer a broad understanding of surgical site infections and, therefore, help to improve the outcome for patients facing the challenges of breast surgery.

We encourage you, our reader, to: explore the contents, engage with the material and join us in the pursuit of excellence in surgical practice! We, the authors, are convinced that we can all take collective action to reduce surgical site infections and improve the overall quality of care in breast surgery!

The Authors

Introduction

An infection is the invasion, proliferation, and growth of invasive microorganisms (such as bacteria, viruses, fungi, or parasites) within the body, disrupting normal functions and frequently eliciting an immune response, which may result in illness or disease if the pathogens inflict tissue damage and surpass the body’s defences. The initial phase of an infectious disease involves the entry of germs, their reproduction, and the probable manifestation of symptoms such as fever, discomfort, or exhaustion.

According to Costanzo [2], A surgical site infection (SSI) is defined as an infection linked to a surgical procedure that occurs at or near the incision site within 30 days after the operation, or within 90 days if prosthetic materials were used. Extensive research has been carried out to identify the causes, risk factors, and potential treatment options for SSIs. With the rising popularity of breast surgery (as seen in Graph 1), plastic surgeons are expected to face a greater number of patients exhibiting surgical site infections (SSIs). Many approaches try to reduce SSI risk in surgical patients. These therapies can be given pre-, intra-, and post-op. Soap and antiseptics are used to decontaminate skin, barriers are utilised to prevent microorganisms from entering incisions, and the patient’s biological systems are optimised to facilitate recuperation. Decontamination and barrier strategies can target surgical patients and staff, as explained also by Liu.

Índice

PREFACE

I. THEORETICAL MATTERS CONCERNING THE INFECTIONS OF THE BREAST

1.A. DEFINITION OF THE SUBJECT
1.B. ANATOMY OF THE BREAST
1.C. CLINIC AND PHYSIOPATHOLOGY OF BREAST INFECTIONS

2. BREAST CANCER SURGERY AND INFECTIONS

3. THE ANTISEPTIC TREATMENT OF THE SURGICAL DRAINS

4. THE ANTISEPTIC TREATMENT OF THE SKIN

5. CONSEQUENCES OF THE SURGICAL SITE INFECTIONS

6. THE APPLICATION OF NEGATIVE WOUND THERAPY

7. “PROBLEMS” SPECIFIC TO BREAST IMPLANTS

8. TISSUE EXPANDERS

9. THE ASSOCIATION BETWEEN SURGICAL SITE INFECTIONS AND OTHER COMPLICATIONS

10. DONOR SITE COMPLICATIONS FOLLOWING AUTOLOGOUS BREAST RECONSTRUCTION

11. RISK FACTORS AND PREDICTORS OF COMPLICATIONS IN BREAST SURGERY

12.COVID-19

13. LOW INCOME AND MIDDLE INCOME COUNTRIES

14. TYPES OF INTERVENTIONS

15. INFECTION MANAGEMENT-PART I

GENERAL ASPECTS

16. INFECTION MANAGEMENT-PART II

PALLIATIVE (“TOILET” MASTECTOMY)

17. CONCLUSIONS

GLOSSARY, ACRONYMS AND EXPLANATIONS FROM THE THEORETICAL PART OF THE BOOK (PART I)

18. REVIEW QUESTIONS

I. PRACTICAL MATTERS CONCERNING THE INFECTIONS OF THE BREAST

About the authors

REFERENCES