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Arch Plast Surg > Volume 44(6); 2017 > Article
Archives of Plastic Surgery 2017;44(6):516-522.
DOI: https://doi.org/10.5999/aps.2017.01025    Published online October 27, 2017.
Salvage of Infected Breast Implants
Joon Ho Song1, Young Seok Kim1, Bok Ki Jung1, Dong Won Lee2, Seung Yong Song2, Tai Suk Roh1, Dae Hyun Lew2
1Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Gangnam Severance Hospital, Seoul, Korea
2Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Correspondence:  Tai Suk Roh, Tel: +82-2-2019-3422, Fax: +82-2-2019-3422, 
Email: ROHTS@yuhs.ac
Received: 13 June 2017   • Revised: 25 October 2017   • Accepted: 20 October 2017
Abstract
Background
Implant-based breast reconstruction is being performed more frequently, and implants are associated with an increased risk of infection. We reviewed the 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, wound culture pathogens, and other complications, including seroma, hematoma, and mastectomy skin necrosis. Additionally, we examined the mastectomy type, the use of acellular dermal matrix, the presence of an underlying disease such as hypertension or diabetes, and axillary node dissection.

Results

The total infection rate was 4.99% (58 of 1,163 cases) and the total salvage rate was 58.6% (34 of 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 the cases of explantation. Explantation after infection was performed more often in patients who had undergone 2-stage expander/implant reconstruction than in those who had undergone direct-to-implant reconstruction.

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 the patient’s clinical symptoms do not improve, surgeons should consider implant removal.
Keywords: Breast implants / Infection / Methicillin-resistant Staphylococcus aureus / Seroma


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