Analysis of Infected Implant Based Breast Reconstruction:Salvage of infected breast implant.

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Analysis of Infected Implant Based Breast Reconstruction:Salvage of infected breast implant.

Arch Plast Surg. 2017 Oct 27;:

Authors: Song JH, Kim YS, Jung BK, Lee DW, Song SY, Roh TS, Lew DH

Abstract
Background: Implant-based breast reconstruction is increasingly being performed and implants are associated with an increased risk of infection. We reviewed clinical features of cases of implant infection and investigated the risk factors for breast device salvage failure.
Methods: We retrospectively analyzed 771 patients who underwent implant-based breast reconstruction between January 2010 and December 2016. Age, body mass index, chemotherapy history, radiation exposure and smoking history were assessed as potential risk factors for postoperative infection. We also evaluated the presence and onset of infection symptoms and wound culture pathogens and other complications including seroma, hematoma, and mastectomy skin necrosis. Additionally parameters examined included mastectomy type, use of acellular dermal matrix, underline disease like hypertension or diabetes and axillary node dissection.
Results: Total infection rate was 4.99% (58/1163 cases) and total salvage rate was 58.6% (34/58). The postoperative duration to closed suction drain removal was significantly different between the cellulitis and implant removal groups. Staphylococcus aureus, infection was most frequently found, with methicillin resistance in 37.5% of explantation cases. Explantation after infection was performed more often for two-stage expander/implant reconstruction than for direct-to-implant reconstruction. Negative bacterial culture results were reported in 8.33% of patients with explantation. Wound-associated complications like seroma were noted in 39.6% (23/58) patients.
Conclusions: Preventing infection is essential in implant-based breast reconstruction. The high salvage rate argues against early implant removal. However when infection is due to methicillin-resistant S. aureus and clinical symptoms do not improve, surgeons should consider implant removal.

PMID: 29076316 [PubMed - as supplied by publisher]