Infection Outcomes in Implant-Based Breast Reconstruction: Five-Year Experience with the GAPS Protocol.

Cohort studyPlastic and reconstructive surgery· Jul 2026

Infection Outcomes in Implant-Based Breast Reconstruction: Five-Year Experience with the GAPS Protocol.

Bo Hyun Kong, Omar Jean-Baptiste, Owen Brown … Gabriela Del Pilar Garcia Nores

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Breast ReconstructionCohort studyClinical practiceQ1IF 2.8

GAPS protocol associated with lower surgical-site infection risk after implant-based breast reconstruction

Infection Outcomes in Implant-Based Breast Reconstruction: Five-Year Experience with the GAPS Protocol.

Bo Hyun Kong … Gabriela Del Pilar Garcia Nores

Plastic and reconstructive surgery · Jul 2026 · Q1 in Surgery

Background

Surgical-site infections (surgical-site infections) are a major complication of implant-based breast reconstruction (implant-based breast reconstruction), with no widely adopted prevention protocol.

Methods

We performed a quasi-experimental prospective cohort study with historical controls of immediate implant-based breast reconstruction at a single academic health system (January 2018-December 2023).

n = 915 patients

Results

protocol lowered infection risk by about a third

RR 0.66 (95% CI 0.45 to 0.96)

CI excludes the null - significant

More results

Among 915 patients (1,500 breasts), the protocol cohort (604 patients, 994 breasts) had lower surgical-site infections rates than controls (311 patients, 506 breasts): 5.7% versus 8.7% (P = .03).

More results

Across single-covariate adjustments (age, prior radiation, smoking, implant plane, seroma, and acellular dermal matrix [ADM]), the protocol remained directionally protective (RR range 0.57-0.76).

Protocol adherence was approximately 80%, with an ARR of 2.96% and NNT of 34.

“

Conclusion · 1 of 2

The GAPS protocol was associated with reduced surgical-site infections after implant-based breast reconstruction with directionally consistent protective estimates across adjusted models.

Conclusion · 2 of 2

These findings support structured perioperative infection-prevention protocols to improve reconstructive outcomes and reduce healthcare burden.

Infection Outcomes in Implant-Based Breast Reconstruction: Five-Year Experience with the GAPS Protocol.

Infection Outcomes in Implant-Based Breast Reconstruction: Five-Year Experience with the GAPS Protocol.

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