title: Innovative Management of Implant Exposure in ADM/Implant-Based Breast Reconstruction with Negative Pressure Wound Therapy.
abstract: BACKGROUND
  One-stage implant-based breast reconstruction has been recently improved by the introduction of biological [acellular dermal matrix (ADM)] and synthetic meshes. Advantages of ADMs in implant-based breast reconstruction derive from the expansion of the space available for the direct positioning of an implant, but their use could be associated with several complications. Although the majority of complications can be easily managed, mistakes in dealing with the first clinical signs of a potential adverse event can lead to implant loss.
  
  
  METHODS
  We report a case of ADM/implant exposure following NAC-sparing mastectomy and immediate implant-based reconstruction, successfully managed with an innovative staged treatment using negative pressure wound therapy, which allowed a rapid re-positioning of the prosthesis after complete clearance of bacteria from the implant pocket.
  
  
  CONCLUSIONS
  The safest strategy to manage implant exposure and concomitant bacterial growth is reported to be implant removal and delayed re-positioning after several months, following prolonged targeted antibiotic therapy. Our case shows how a short-time implant re-positioning following implant removal for implant exposure could be successfully pursued thanks to the shrewd use of negative pressure wound therapy with great advantages in terms of patient satisfaction and post-operative quality of life, offering women experiencing this complication the option of not delaying reconstruction for months after resolution of the complication, potentially avoiding major surgical procedures such as autologous tissue reconstructions.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Department of Surgery, Breast Unit, University Hospital "Federico II", Naples, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Accurso
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy. nicolarocco2003@gmail.com.
authors.forename: Nicola
authors.identifier: http://orcid.org/0000-0001-6941-7873
authors.initials: N
authors.lastname: Rocco
authors.affiliation: Department of Surgery, Breast Unit, University Hospital "Federico II", Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Accardo
authors.affiliation: Department of Surgery, Breast Unit, University Hospital "Federico II", Naples, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Reale
authors.affiliation: Department of Surgery, Breast Unit, University Hospital "Federico II", Naples, Italy.
authors.forename: Carmela
authors.initials: C
authors.lastname: Salerno
authors.affiliation: Department of Clinical and Experimental Medicine Flaviano Magrassi, Clinical Medicine Hospital Unit, Ambulatory of Vulnology, Second University of Naples, Naples, Italy.
authors.forename: Edi
authors.initials: E
authors.lastname: Mattera
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Naples "Federico II", Naples, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Andrea
mesh_terms: D019928:Breast Implantation / Q000009:adverse effects* / Q000379:methods; D018427:Breast Implants / Q000009:adverse effects; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods; D015414:Mastectomy, Subcutaneous / Q000379:methods*; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D011184:Postoperative Period; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000601:surgery*; D014945:Wound Healing / Q000502:physiology
keywords: A cellular dermal matrix; Breast reconstruction; Implant exposure; Negative pressure wound therapy