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Periprosthetic infection is a devastating complication following breast reconstruction with prostheses. Traditional surgical principles dictate removal of the prosthesis to control infection. Although successful salvage of prostheses in the presence of periprosthetic infections has been reported in the plastic and other surgical literature, salvage procedures remain seldom practiced. Reports in the plastic surgery literature have been limited to implant salvage following cosmetic breast augmentation and subcutaneous mastectomy with implants. Salvage of saline-filled expander prostheses used in breast reconstruction following mastectomy for cancer has not been previously reported. The authors review their experience with implant salvage in patients with periprosthetic infections following breast reconstruction for a 6-year period. Fourteen patients (13 with saline-filled expander prostheses and one with silicone prosthesis) underwent implant salvage. Salvage of the breast reconstruction was successful in nine patients. Staphylococcus aureus infection was associated with poorer salvage rate (p = 0.023). Previous radiotherapy to the chest wall did not affect the salvage outcome (p = 0.50). In selected patients, immediate salvage of a breast reconstruction in the presence of prosthesis-related infection remains an alternative to implant removal followed by delayed reconstruction.

Elective treatment of the clinically negative neck in the management of early oral tongue cancers remains controversial. A retrospective review of 71 patients with T1, 2 N0M0 squamous cell carcinoma of the oral tongue treated at the Royal Marsden Hospital was carried out. Cervical nodal recurrence at 2 years was 17% in the group of patients who received elective neck treatment as compared to 43% in the group who had observation of the neck and the difference is statistically significant (P = 0.025). The difference in 5-year survival between the group who had elective neck treatment and the group who did not (75% versus 65%) was not statistically significant. Until future research allows us to be more selective on the basis of a reliable panel of histological and/or biological markers for propensity to nodal metastases, elective neck treatment should be considered in the initial management of the patients with early oral tongue cancer.