title: Management of exposed, infected implant-based breast reconstruction and strategies for salvage.
abstract: BACKGROUND
  Complications of implant-based breast reconstruction are rare but mastectomy flap necrosis and peri-implant infection are the most frequent and remain an important cause of early implant failure. This study aimed to compare the results of three different management strategies employed to deal with these complications at our institution.
  
  
  METHODS
  A consecutive series of 71 infected/exposed prostheses in 68 patients over a 20-year period were analysed. Management strategies included explantation and delayed reconstruction, implant salvage and explantation and immediate autologous reconstruction.
  
  
  RESULTS
  Only 19 of 45 (42%), managed with implant removal, went on to delayed reconstruction. Methods of delayed reconstruction were distributed equally between implant-only, implant and autologous tissue and autologous-only reconstructions. The implant was successfully salvaged in nine cases, but reducing the implant size or introducing new tissue as a flap increased the success from 45% to 53%. Three patients with infected implant-only breast reconstruction underwent explantation and immediate conversion to autologous-only reconstructions.
  
  
  CONCLUSIONS
  All the three interventions reviewed here have their place in the management of infected implant-based breast reconstructions. It is noteworthy that following implant removal, the likelihood of the patient proceeding to delayed reconstruction of any kind is similar to the likelihood of successful salvage (42% vs. 45%). This study population had high numbers of exposed implants in irradiated fields. Reducing implant size or introducing new tissue in the form of a flap increases the chances of successful implant salvage. In the presence of mild infection, removal of exposed/infected implants and immediate conversion to an autologous-only reconstruction can prove to be successful.
authors.affiliation: Département de Chirurgie, Institut Curie, 26 rue d'Ulm, Paris 75005, France. simonbennett@doctors.org.uk
authors.forename: S P H
authors.initials: SP
authors.lastname: Bennett
authors.forename: A D
authors.initials: AD
authors.lastname: Fitoussi
authors.forename: M G
authors.initials: MG
authors.lastname: Berry
authors.forename: B
authors.initials: B
authors.lastname: Couturaud
authors.forename: R J
authors.initials: RJ
authors.lastname: Salmon
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000098:blood supply / Q000473:pathology*; D019928:Breast Implantation / Q000009:adverse effects*; D018427:Breast Implants / Q000382:microbiology*; D020878:Device Removal; D005260:Female; D006801:Humans; D008875:Middle Aged; D009336:Necrosis; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000628:therapy*; D013524:Surgical Flaps / Q000009:adverse effects / Q000098:blood supply* / Q000473:pathology; D013997:Time Factors