Breast Implant Infections after Surgical Reconstruction in Patients with Breast Cancer: Assessment of Risk Factors and Pathogens over Extended Post-Operative Observation

Abstract

Extended post-operative surveillance is indicated, at least for the first six months after breast implant placement, particularly for women who need radiotherapy or chemotherapy after implant surgery. Gram-negative bacilli may be involved more often in late infections than otherwise expected. This finding may influence initial empiric antibiotic treatment.

The microbial epidemiology of breast implant infections in a regional referral centre for plastic and reconstructive surgery in the south of France

“…A higher proportion (42-44%) of Gram-negative bacilli has been reported recently in breast implant infection after surgical reconstruction in patients with breast cancer. 10,22 No significant difference in Gram-negative bacilli between breast implant infections after surgical reconstruction in patients with breast cancer compared with breast implant infections after aesthetic breast augmentation were found (3/14 vs. 7/23, p = 0.7099). It was found that Gram-negative bacilli breast implant infections were not significantly involved in late infections compared to acute infections (7/21 vs. 3/16, p = 0.4613).…”

Clinical and Microbiological Characterization of Late Breast Implant Infections after Reconstructive Breast Cancer Surgery

“…For this reason we decided to evaluate patients according to a graded definition of infection derived and adapted from infections in neutropenic patients [24]. Post-operative implant infections types [2] were defined as possible (fever, minimal local edema, and inflammation resolving on empiric antibiotic therapy), probable (cellulitis, leukocytosis, systemic inflammation, echographic evidence of inflammation, or peri-prosthetic liquid accumulation, without microorganism isolation on echographic needle aspiration or blood culture), and proved (criteria for probable infection with cellulitis and presence of purulent discharge and microorganism isolation). Implant infections were further defined according to the time lapse after implantation as ''early'' when occurring within 60 d from surgery (DFS) and ''late'' when occurring >60 DFS.…”

“…Indeed, not all reconstructive breast implant infections, in cancer patients, occur early after surgery (i.e., <60 d) [2,15]. Late breast implant infection occurring months to years after surgery still represents a grey area of our understanding with particular regard to incidence, etiology, physiopathology, and management, and are sometimes considered rare chance events in everyday clinical practice.…”

Infections associated with body modification

“…The risk of infection is much higher (up to 10 times) in patients undergoing reconstructive surgery as compared to in those undergoing aesthetic surgery because the former group of patients have a higher incidence of underlying (systemic and local) comorbidities, prior chemotherapy and radiotherapy, and a greater degree of local tissue trauma. 22,89 The use of human acellular dermal matrix for cosmetic breast augmentation is associated with a higher risk of infection (relative risk 2.47) and other complications as compared to conventional submuscular reconstructions. 28 The routes of infection for breast implants are similar to those for other implants such as joint prostheses and heart valves.…”