The infected breast prosthesis after mastectomy reconstruction: successful salvage of nine implants in eight consecutive patients.
BACKGROUND
The use of tissue expanders and permanent implants has an established role in breast reconstruction after mastectomy. Periprosthetic infection, however, represents a known complication. The most conservative approach to severe or recalcitrant prosthetic infection remains removal of the device. However, removal makes subsequent reinsertion and reexpansion more difficult, with less predictable cosmetic results. The authors believe that timely surgical intervention directed toward salvage of infected breast prostheses can be successful, without demonstrating increased capsular contracture.


METHODS
The authors present nine consecutive cases of infected breast implants (nine implants in eight patients). All patients had previously undergone mastectomy for malignancy and immediate expander/implant reconstruction. Six patients had localized infections that failed to respond to oral antibiotics and two women initially presented with systemic infection. All patients were placed on intravenous antibiotics followed by drainage of fluid, manual debridement and curettage of the infected pocket, device exchange, and postoperative antibiotics.


RESULTS
All nine infected breast prostheses responded to this approach and currently remain intact and without recurrent infection. Mean time to follow-up for all patients was 14.6 months (range, 10 to 25 months).


CONCLUSIONS
In patients with severely infected breast prostheses, timely operative intervention can salvage the previously "unsalvageable" implant; in addition, the surgically replaced implants did not develop severe capsular contractures. Surgical salvage of severely infected breast prostheses after mastectomy is a treatment option that should be considered when dealing with severe or recalcitrant infection in a suitable patient.
Chun
Jin K
JK
New York, N.Y. From the Division of Plastic and Reconstructive Surgery, Mount Sinai Medical Center.
Schulman
Matthew R
MR
D000328:Adult; D018427:Breast Implants / Q000009:adverse effects*; D013293:Enterococcus faecalis; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000601:surgery*; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012074:Remission Induction; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000601:surgery*; D013212:Staphylococcus epidermidis
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