Infections in breast implants: a review with a focus on developing countries

Abstract

The risk of surgical site infection is always present in surgery; the use of prosthetic materials is linked to an increased possibility of infection. Breast augmentation and breast reconstruction with implants are gaining popularity in developing countries. Implant infection is the main complication related to breast aesthetic and reconstructive surgery. In the present paper, we reviewed the current microbiological knowledge about implant infections, with particular attention to risk factors, diagnosis, clinical management, and antibiotic prophylaxis, focusing on reports from developing countries. After breast aesthetic surgery, up to 2.9% of patients develop a surgical site infection, with an incidence of 1.7% for acute infections and 0.8% for late infections. The rate of surgical site infection after post-mastectomy breast reconstruction is usually higher, ranging from 1% to 53%. The clinical features are not constant, and bacterial culture with antibiogram is the gold standard for diagnosis and for identification of antibiotic resistance. While waiting for culture results, empiric therapy with vancomycin and extendedspectrum penicillins or cephalosporins is recommended. Some patients require removal of the infected prosthesis. The main methods to bring down the risk of infection are strict asepsis protocol, preoperative antibiotic prophylaxis, and irrigation of the surgical pocket and implant with an antibiotic solution.Key words: breast implant infections; acute infections; late infections; fungal infections; rare infections. EpidemiologyImplant infection is the main complication related to breast aesthetic and reconstructive surgery [1]. After breast aesthetic augmentation, up to 2.9% of women are affected by infection [2], with an incidence of 1.7% for acute infections versus an incidence of 0.8% for late infections, as confirmed by retrospective cohort studies with long-term follow-ups [1]. In developing countries, this problem is even more prevalent; surgery has a 50% rate of possible complications, of which infection is the main complication [3]. The rate of surgical site infection after post-mastectomy breast reconstruction is usually higher, ranging from 1% to 53% [4,5]. In breast reconstruction, a higher rate of infection was reported with expander implants compared to reconstruction with autologous tissue such as latissimus dorsi flaps [6]. The highest rates were found in women undergoing immediate reconstruction [4]. The reported number of infections after mammary augmentation and reconstruction is lower than the real incidence, because of the lack of a surveillance network of patients based on long-time follow-ups. The economic commitment for management of implant infections is significant. Kirkland et al. [7] reported an increase of hospital permanence for surgical site infection of 6.5 days, with related health care costs. In the United States, health care costs for surgical site infection after breast surgery were estimated to be about $4,091 [7], or $574 in the outpatient setting [9]...

Silicone-induced granuloma of breast implant capsule (SIGBIC): similarities and differences with anaplastic large cell lymphoma (ALCL) and their differential diagnosis

“…Coagulase-negative staphylococci and Propionibacterium acnes are the most common strains. The diagnosis is made by liquid culture of the material obtained by fine-needle aspiration, and empirical treatment with vancomycin should be conducted with antibiotics until the results of antibiogram susceptibility testing become available, based on the high number of infections due to β-lactam resistant pathogens, among which are methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci22 (Figure 9). …”

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

“…11 The early and accurate identification of bacteria is a critical requirement for prompt and appropriate antimicrobial treatment of breast implant infections. 12 The arrival of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) in the study centre has increased the speed and identification of the common and rare bacterial species involved in human infection. 13 In this study, the clinical and microbiological features of breast implant infections managed in a regional referral centre for plastic/ reconstructive surgery in the south of France were reviewed retrospectively.…”

An overview of Staphylococcus epidermidis and Staphylococcus aureus with a focus on developing countries

“…Staphylococcus aureus together with Staphylococcus epidermidis rank first among causative agents for these kinds of commensal infections. Therefore, they became the major causes of infections of medical implants and nosocomial infections worldwide, and especially in developing countries [2].…”