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

Abstract

Background In recent years, implant-based breast reconstruction has been performed because of its simplicity, short operation time, and rapid recovery of patients. Several studies have reported treatment methods for implant surgery-related infection, which is a serious complication. The aim of this study was to introduce our strategy for salvaging infected implants and to evaluate its effectiveness.<br/>Methods The authors performed a retrospective study of 145 cases from 132 patients who underwent implant-based breast reconstruction from January 2012 to December 2018. Empirical antibiotics were immediately administered to patients with suspected infections. The patients then underwent salvage treatment including appropriate antibiotics, ultrasonography-guided aspiration, debridement, antibiotic lavage, and implant exchange through a multidisciplinary approach. Patient demographics, operative data, duration until drain removal, adjuvant treatment, and complications were analyzed.<br/>Results The total infection rate was 5.5% (8/145). A longer indwelling catheter period and adjuvant treatment were significantly associated with infection. The salvage treatment showed a success rate of 87.5% (7/8). Seven patients who received early aggressive salvage treatment recovered from infection. One patient with methicillin-resistant <i>Staphylococcus aureus</i>, who received salvage treatment 11 days after symptom onset, did not respond to drainage and antibiotic treatment. That patient subsequently underwent explantation.<br/>Conclusions In implant-based breast reconstruction, prevention of infection is of the utmost importance. However, if an infection is suspected, proactive empirical antibiotic therapy and collaboration with the necessary departments are required. Through a multidisciplinary approach and proactive early management, swift and appropriate salvage should be performed.

Management of complications following implant-based breast reconstruction: a narrative review

“…Upon diagnosis of infection, prompt initiation of empiric antibiotics is paramount, followed by close clinical observation to determine the appropriateness of implant salvage. Mild infections may be treated with oral antibiotics (10- to 14-day course of typically clindamycin, trimethoprim-sulfamethoxazole, linezolid, or ciprofloxacin) ( 27 , 29 , 35 ). However, moderate to severe cases of infection necessitate intravenous antibiotics, with coverage of methicillin-resistant Staphylococcus aureus (MRSA), coagulase-negative staphylococci, and gram-negative bacteria (e.g., vancomycin and piperacillin-tazobactam) ( 27 , 29 , 35 , 36 ).…”

“…Mild infections may be treated with oral antibiotics (10- to 14-day course of typically clindamycin, trimethoprim-sulfamethoxazole, linezolid, or ciprofloxacin) ( 27 , 29 , 35 ). However, moderate to severe cases of infection necessitate intravenous antibiotics, with coverage of methicillin-resistant Staphylococcus aureus (MRSA), coagulase-negative staphylococci, and gram-negative bacteria (e.g., vancomycin and piperacillin-tazobactam) ( 27 , 29 , 35 , 36 ). If rapid improvement is observed while on intravenous antibiotics, patients may be transitioned to an oral regimen.…”

A Simple Technique Using Peri-Prosthetic Irrigation Improves Implant Salvage Rates in Immediate Implant-Based Breast Reconstruction

“…A new implant was placed, and a drain was inserted in all patients. With this technique, they reported a success rate of 87.5% [21]. Although the number of surgical interventions is small, it raises the possibility that the probable timing of intervention may have a potential impact on salvage rates.…”

Prepectoral breast reconstruction with complete anterior implant coverage using a single, large, square-shaped acellular dermal matrix

“…Despite our compliance with the hospital’s infection prevention protocol while performing breast reconstruction using the DTI technique [ 13 ], occasional cases of infection still occur. In such cases, our team immediately administers empirical antibiotics and refers the patient to other departments to rapidly diagnose and establish a treatment plan so that proactive surgical intervention can be considered alongside appropriate drug therapy [ 22 ]. In the single case of infection in this study, broad-spectrum antibiotics were administered immediately upon the appearance of symptoms.…”