Researchers at Washington University School of Medicine have developed a pioneering method to detect infections in breast reconstruction patients weeks before symptoms appear, offering hope for improved outcomes, fewer surgeries, and reduced emotional and financial burdens.
Breast cancer affects one in eight women in the U.S., and about half of these patients undergo mastectomies. Many choose breast reconstruction, often with implants, but infection rates remain high. When infections occur, patients typically require intravenous antibiotics and, in severe cases, implant removal. These complications can delay cancer treatment and add significant emotional stress.
The new tool, developed by a team led by Jeffrey P. Henderson, MD, PhD, professor in the John T. Milliken Department of Medicine, identifies biomarkers of infection in the fluid drained from reconstructed breasts. These biomarkers appear days or even weeks before traditional clinical signs such as redness and swelling, allowing for earlier intervention.
“The ability to identify a molecular signature of infection early opens the possibility of surveillance as part of standard care,” Henderson said. “Early treatment could prevent prolonged therapy, additional surgeries, and implant loss, significantly improving patient outcomes.”
From Clinical Observation to Molecular Discovery
The study stemmed from observations by Margaret A. Olsen, PhD, a retired professor of medicine specializing in hospital infections, who noted high infection rates among post-mastectomy implant patients. Collaborating with plastic surgeons at WashU Medicine, the researchers identified the need for a simple, definitive test for infection.
Using metabolomics—the study of small molecules produced during cellular processes—Henderson and his team analyzed fluid samples from 50 patients. They compared samples from women who developed infections with those who did not, identifying metabolites linked to infection, including markers that signal more serious infections requiring aggressive treatment.
“Evidence from this study supports proactive interventions to predict and address infections before they become clinically significant,” said Justin M. Sacks, MD, director of the Division of Plastic and Reconstructive Surgery at WashU Medicine. “Such measures could substantially reduce complications, implant loss, and reconstructive failures.”
A Future Point-of-Care Test
The findings could lead to a simple, routine test for women after breast reconstruction. A positive result would allow physicians to start antibiotics early, while a negative result would prevent unnecessary use, supporting responsible antibiotic stewardship and combating resistance, noted coauthor Terence M. Myckatyn, MD, a plastic and reconstructive surgeon at WashU Medicine.
The team is now planning additional studies to validate these results and hopes to develop a clinical diagnostic tool. Beyond breast reconstruction, metabolomic insights may also guide targeted strategies for other post-surgical infections, potentially revealing new drug targets.
“Even with meticulous surgery, infections still occur,” Myckatyn said. “Identifying biomarkers before symptoms appear is a game-changer.”
The study, “Small molecule correlates of infection precede infection diagnosis in breast implant reconstruction patients,” will be published in the Journal of Clinical Investigation on Feb. 16.
About WashU Medicine
WashU Medicine is a global leader in academic medicine, research, and patient care, with more than 3,000 faculty and a research portfolio ranking second among U.S. medical schools. Physicians practice across 130 locations, including Barnes-Jewish and St. Louis Children’s hospitals, and Siteman Cancer Center, Missouri’s only National Cancer Institute-designated comprehensive cancer center. WashU Medicine invests over $1 billion annually in clinical and basic research and medical training programs.
