Management of exposed, infected implant-based breast reconstruction and strategies for salvage

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

“…2,31 Some studies have reported successful one-stage prosthesis exchange or salvage attempts, consisting of prosthesis removal and cleaning of the compartment. [32][33][34] The reported success rate of early salvage followed by one-stage prosthesis exchange in cases of breast infection that are not too severe is in the range of 45% to 76.7%. [32][33][34] Two of the cases in the present series treated by salvage without implant removal both relapsed and required complete implant removal.…”

“…[32][33][34] The reported success rate of early salvage followed by one-stage prosthesis exchange in cases of breast infection that are not too severe is in the range of 45% to 76.7%. [32][33][34] Two of the cases in the present series treated by salvage without implant removal both relapsed and required complete implant removal. Due to the lack of randomized controlled trials, we do not recommend one-stage prosthesis exchange in severe cases of breast implant infection.…”

One-Step Salvage of Infected Prosthetic Breast Reconstructions Using Antibiotic-Impregnated Polymethylmethacrylate Plates and Concurrent Tissue Expander Exchange

“…Specifically, the rates of infection have been reported to range from 1% to 35.4% in patients who underwent expander-implant reconstruction. 2,3 The traditional approach to a severe periprosthetic infection with poor response to intravenous antibiotics and percutaneous drainage has been explantation followed by a 6-month waiting period to allow for complete resolution before secondary reconstructive efforts. [4][5][6] Although this method is effective, it is associated with its own undesirable sequelae, including scarring, contraction, and loss of the breast skin envelope.…”

Management of complications in reconstructive mammoplasties with prostheses: systematic review

“…However, in Prince et al 15 , removing the most severe cases presented higher rates of saved prostheses. Stratification of postoperative complications, in Bennet et al 16 , is similar to Prince et al 15 and Peled et al 14 , in which the management of severe infection cases consisted in prosthetic removal and late reconstruction. In the other cases, there was an attempt to save the prostheses, with or without the support of myocutaneous flaps, depending on the quality of the remaining skin.…”

“…The classification of the infection degree was performed in all seven studies; and even though this stratification was not uniform, the advanced level was among the main causes of prosthetic loss. In four studies, the severity of infection implicated in removal of the prosthesis and late reconstruction, in case the patient desired so [13][14][15][16][17][18][19] . The rate of saved prostheses after stratification of complications -including the use of the same prosthesis or its replacement by another device -varied from 45 to 100%.…”