Salvage of Infected Breast Implants

Abstract

BackgroundImplant-based breast reconstruction is being performed more frequently, and implants are associated with an increased risk of infection. We reviewed the clinical features of cases of implant infection and investigated the risk factors for breast device salvage failure.MethodsWe retrospectively analyzed 771 patients who underwent implant-based breast reconstruction between January 2010 and December 2016. Age, body mass index, chemotherapy history, radiation exposure, and smoking history were assessed as potential risk factors for postoperative infection. We also evaluated the presence and onset of infection symptoms, wound culture pathogens, and other complications, including seroma, hematoma, and mastectomy skin necrosis. Additionally, we examined the mastectomy type, the use of acellular dermal matrix, the presence of an underlying disease such as hypertension or diabetes, and axillary node dissection.ResultsThe total infection rate was 4.99% (58 of 1,163 cases) and the total salvage rate was 58.6% (34 of 58). The postoperative duration to closed suction drain removal was significantly different between the cellulitis and implant removal groups. Staphylococcus aureus infection was most frequently found, with methicillin resistance in 37.5% of the cases of explantation. Explantation after infection was performed more often in patients who had undergone 2-stage expander/implant reconstruction than in those who had undergone direct-to-implant reconstruction.ConclusionsPreventing infection is essential in implant-based breast reconstruction. The high salvage rate argues against early implant removal. However, when infection is due to methicillin-resistant S. aureus and the patient’s clinical symptoms do not improve, surgeons should consider implant removal.

Protocol for Prevention and Monitoring of Surgical Site Infections in Implant-Based Breast Reconstruction: Preliminary Results

“…Our data showed a 46.2% prosthesis salvage rate for SSIs that were treated with parenteral antibiotics only. Our salvage rate is comparable to those reported by other authors who have employed both surgical and medical treatments [ 27 , 28 , 29 ].…”

Significance of Infections in Implant Loss After Breast Reconstruction in the Course of Breast Cancer Treatment

“…In turn, in the work of Chidester et al (2016) P. aeruginosa was the most common causative agent of infections and accounted for 26.8% of them. Research carried out by Song et al (2017) indicates the involvement of A. baumanii in infections alongside with P. aeruginosa. In our work more frequently than in the previous studies (Feldman et al 2010;Seng et al 2015;Chidester et al 2016;Song et al 2017), Gram-negative bacilli were isolated.…”

Strategy for salvaging infected breast implants: lessons from the recovery of seven consecutive patients

“…One of the reasons for salvage failure is the suboptimal treatment of MRSA infection. According to a report by Song et al [ 21 ], MRSA is the most commonly identified strain in implantrelated infections and an important factor for explantation. Yii and Khoo [ 22 ] confirmed that the salvage rate was lower in breast reconstructions with MRSA infection.…”

“…Yii and Khoo [ 22 ] confirmed that the salvage rate was lower in breast reconstructions with MRSA infection. A study of 69 patients with infected or exposed breast implants by Spear and Seruya in 2010 reported that infection with Gram-negative rods, MRSA, and Candida parapsilosis was associated with a higher probability of salvage failure [ 15 , 21 ]. The infection sources could include community-acquired pathogens and contamination from medical staff who participated in the operation.…”