Reducing Surgical-Site Infection in Implant-Based Breast Reconstruction: Clinical Impact of the GAPS Protocol over Five Years

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The five-year prospective cohort study demonstrated that the implementation of the GAPS protocol—a 12-step gloves, antimicrobial soak, pocket irrigation, and sterile field procedure—significantly reduced surgical-site infections (SSIs) in implant-based breast reconstruction (IBBR) by approximately one-third. The protocol achieved a moderate absolute risk reduction (ARR) of 2.96%, with a number needed to treat (NNT) of 34, suggesting meaningful clinical benefits in a high-risk surgical population.

Adjustments for common confounders such as age, prior radiation, smoking status, implant plane, seroma formation, and use of acellular dermal matrix consistently demonstrated protective effects of the protocol, supporting its robustness. Although some adjusted analyses attenuated statistical significance, all estimates favored infection reduction.