Analyzing the Effects of a Standardized Perioperative Breast Reconstruction Protocol at a Large Urban Institution

BACKGROUND: Implant-based breast reconstruction (IBBR) remains one of the most performed techniques in post-mastectomy reconstruction, yet significant variability in procedural management remains. Postoperative infections are a major source of morbidity and reconstructive failure. This study evaluates the impact of an evidence-based, standardized protocol on postoperative outcomes in patients undergoing IBBR. METHODS: An evidence-based perioperative protocol was implemented for patients undergoing IBBR at a single urban institution from December 2019 to April 2025 (Table 1). Intraoperative protocol adherence, postoperative infection and reconstructive failure rates were recorded. A historical cohort of patients treated prior to implementation served as control. RESULTS: A total of 918 patients (1,502 breasts) underwent IBBR following protocol implementation. Overall infection rates decreased following protocol implementation (17.6% to 11.8%, p<0.05) (Table 2). Salvage rates for major infections improved following protocol implementation, increasing from 21.1% to 46.0% (p<0.05), reducing implant loss following infection. Microbiologic profiles demonstrated a relative decrease in infections attributed to skin flora, and an increased proportion of atypical organisms. Enhanced salvage rates were observed across organism subtypes (Table 3). CONCLUSION: Implementation of a standardized perioperative protocol was associated with a significant reduction in overall infection rates and improved implant salvage following infection. This suggests a meaningful shift in the clinical course and management of postoperative infections after adoption of our protocol.