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

Abstract

Sustained local antibiotic delivery using PMMA implants and expander device exchange can successfully salvage an infected breast implant. Perceived benefits include shorter time to completed reconstruction, preserved skin envelope integrity, and possibly improved long-term aesthetic outcomes.

Serratus anterior muscle flap as a salvage procedure in exposed implant-based breast reconstruction

“…In 2009 Spear further enhanced the knowledge of when and how to attempt reconstruction salvage and introduced the concept of flap coverage to enhance soft tissue coverage and reduce the chance of a new exposure [6]. Recently the use of negative pressure and antibiotic impregnated plates has been described with success to improve fluid drainage and local delivery for drugs and can be promising factors for reconstruction salvage in the future [16,17].…”

Salvage of Infected Prosthetic Breast Reconstructions

“…We found that these atypical organisms can be cleared by sterilization of the prosthetic pocket with antibiotic-impregnated plates or beads, enabling the direct delivery of high bactericidal levels to biofilmproducing organisms. 7 Biofilm formation has implications on the adverse outcomes associated with periprosthetic breast infections. Using a porcine model, Tamboto et al have demonstrated a link between inoculation with biofilm-producing S. epidermidis and development of capsular contracture.…”

“…In 2015, Albright et al 7 presented a pilot study specifically evaluating implant salvage in severe periprosthetic infections using antibiotic-eluding polymethylmethacrylate (PMMA) plates and implant exchange. Severe infection in this series was defined as infections that failed to improve with antibiotics, and required drainage by interventional radiology (if applicable).…”

“…Beads are not the preferred method: They are linked to an increased risk of pressure necrosis. 7 Prior to closure, one or two closed-suction drains were placed in the pocket to allow for serial drain fluid cultures. For the duration of the hospital admission, patients remained on broad-spectrum IV antibiotics, which were tailored and transitioned to oral formulations once the culture results were available and clinical improvement was seen, respectively.…”

“…24,[30][31][32][33][34][35][36][37] Sterilization rates in the literature range from 60% to 100% with infection recurrence rates between 0 to 20%. 7,24,30,31,35 More recently, the use of antibiotic-impregnated PMMA beads in left ventricular assist device infections has resulted in a salvage rate of 65.4% with a recurrence rate of 17.6%. 32 Albright et al 7 reported a breast pocket vancomycin level up to 335 μg/mL on postoperative day 1, and 2.4 μg/mL on postoperative day 48.…”