title: Implant salvage in breast reconstruction with severe peri-prosthetic infection.
abstract: BACKGROUND
  Although treatment of mild peri-prosthetic infection in implant-based breast reconstruction results in high rates of resolution, successful management of severe peri-prosthetic infection remains a significant challenge.
  
  
  METHODS
  In this case series, a protocol utilizing a novel dressing - negative pressure wound therapy with instillation (NPWTi) - for the management of severe peri-prosthetic infection in breast reconstruction patients is described. This is an operative technique involving: (i) explantation of the breast prosthesis and application of the NPWTi dressing to the implant pocket; (ii) change of the NPWTi dressing; (iii) intraoperative fluid/tissue cultures; and (iv) reimplantation of the breast prosthesis when cultures yield no growth.
  
  
  RESULTS
  This protocol was utilized in six cases of severe peri-prosthetic infection in five patients with immediate breast reconstruction for breast cancer or risk-reducing surgery. Cultures of fluid/tissue grew typical and/or unusual organisms. Only one case did not yield an organism. The hospital length of stay upon completion of the protocol ranged from 7-16 days (mean, 12 days). Successful implant salvage was achieved in five of six cases. The protocol was aborted in one case to allow for completion of adjuvant chemotherapy.
  
  
  CONCLUSIONS
  Early findings from this case series suggest that in cases of severe peri-prosthetic infection this novel operative protocol may result in successful implant salvage for breast reconstruction patients. Further studies are needed to more fully elaborate the role of NPWTi to achieve implant salvage in challenging cases of peri-prosthetic infection.
authors.affiliation: Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Farid
authors.initials: F
authors.lastname: Meybodi
authors.affiliation: Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Negin
authors.initials: N
authors.lastname: Sedaghat
authors.affiliation: Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: James
authors.initials: J
authors.lastname: French
authors.affiliation: Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Keighley
authors.affiliation: Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Mitchell
authors.affiliation: Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Elder
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D018427:Breast Implants / Q000382:microbiology*; D001943:Breast Neoplasms / Q000601:surgery*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D020878:Device Removal / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000639:trends; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012092:Replantation / Q000379:methods; D016879:Salvage Therapy / Q000379:methods
keywords: breast implant; breast reconstruction; infection