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

Abstract

Late infection represents a consistent proportion of infections after immediate breast implant reconstruction or prosthesis placement and bear lower chance of salvage after treatment. An increased attention is warranted to improve prevention and treatment strategies.

Analysis of clinical management of infected breast implants and of factors associated to successful breast pocket salvage in infections occurring after breast reconstruction

“…A comparable success rate of treatment was observed for Staphylococcus epidermidis infections (both methicillin sensitive and resistant) compared to S. aureus. Overall, however, coagulase negative Staphylococci represented significantly more common infecting agent compared to S. aureus in agreement with previous reports (Franchelli et al, 2015;Prince et al, 2012). Methicillin resistance was not a factor negatively affecting the possibility to rescue the implant pocket and successfully treat the patient.…”

“…These data confirm previous observations showing Staphylococci (Brand, 1993;Barr et al, 2016) as the main aetiologic agents in breast implant infections, albeit these reports had higher proportions of S. aureus. Here, indeed, a prevalence of Coagulase-negative staphylococci over S. aureus emerges and confirms previous reports at our clinical site (Armstrong et al, 1989;Franchelli et al, 2015).…”

“…Proven infections are defined by the presence of purulent discharge and/or microorganism isolation in addition to other clinical signs. Implant infections are further subdivided into "early" (<60 days from surgery, DFS) and "late" (>60 DFS) infections (Franchelli et al, 2015).…”

“…Among a long list of possible postoperative complications (Georgiade et al, 1982;Schuster et al, 1990;Pusic and Cordeiro, 2003), implant infection represents a devastating event for the patient and a discouraging situation for the surgeon. Infection after implant-based reconstruction occurs at a mean rate of 8% (1-35%) and may vary according to clinical setting and type of procedure (Armstrong et al, 1989;Cordeiro and McCarthy, 2006;Nahabedian et al, 2003;Spear et al, 2004;Franchelli et al, 2015).…”

Exposed Implant after Immediate Breast Reconstruction – Presentation and Analysis of a Clinical Management Protocol

“…7,[16][17][18] The rate of implant infection varies between 1% and 35.4%, and exposure occurs in 0.25% to 8.3% of all implant-based breast reconstructions. [19][20][21][22][23] Several factors are associated with implant infection and exposure: chemotherapy, radiotherapy, tumor size, obesity, older age, axillary dissection, smoking, and the comorbidities of the patient. 16,19,24,25 Traditionally, implant infection is treated with antibiotic therapy, removal of the implant, and delayed reconstruction.…”