Closed Expander Salvage With Dual-port Tissue Expander in Implant-based Breast Reconstruction for High Body Mass Index and Ptotic Patients.

Background: Implant-based (IB) breast reconstruction is efficient and predictable but poses infection risks, especially in patients with high body mass index and/or macromastia. Postoperative infection management lacks standardized protocols for device salvage. Methods: We conducted a 1-year retrospective study on 59 high-risk patients (91 breasts) using dual-port tissue expanders for breast reconstruction. A Wise-pattern skin envelope reduction closed over an inferiorly based adipodermal lining flap was used. Using the dual port, a closed washout protocol with a Betadine solution was initiated for suspected infections. Patient characteristics, infection profiles, and outcomes were recorded. A control cohort of 54 patients (98 breasts) without dual-port expanders was analyzed for infection rates and outcomes. Results: In the experimental cohort, 18% of breasts had postoperative infections, with 38% successfully salvaged using oral antibiotics and the closed washout alone. The overall salvage rate was 75%, and the infectious reconstructive failure rate was 3.3%. Gram-positive bacteria were predominant. The control cohort had a 23.5% infection rate, with only 5% successful salvage and 19 explantations. No statistically significant differences in demographics or infection rates were observed. Conclusions: The study demonstrated the efficacy of a closed wash protocol with dual-port tissue expanders in high-risk IB breast reconstruction. This approach reduces surgical washouts, improves salvage rates, and minimizes reconstruction losses. The dual-port expander shows promise in enhancing salvage outcomes and decreasing reoperations for postoperative infections, providing a valuable addition to IB breast reconstruction strategies. The results suggest potential benefits of the dual-port expander in infection treatment.