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Management of Expander- and Implant-Associated Infections in Breast Reconstruction

  • Original Article
  • Breast Surgery
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Abstract

Background

Periprosthetic infection remains the most common complication after implant-based breast reconstruction. Objectives of the study were to (1) describe our clinical approach and treatment protocol for managing patients with suspected periprosthetic infection, (2) identify the microorganisms causing periprosthetic infections at our institute, and (3) report on outcomes of implant salvage versus explantation.

Methods

A retrospective chart review of patients who were treated with parenteral antibiotics for periprosthetic infection was carried out. Patient characteristics, clinical and laboratory findings, outcomes, treatment modalities and complications were extracted from electronic medical records. Data were compared between patients whose implants were salvaged versus explanted.

Results

Fifty-nine patients with 67 tissue expander (TE)/implants underwent parenteral antibiotic treatment for suspected infection. Thirty-three (49%) of the TE/implants were salvaged. Mean follow-up was 14.3 months. The most commonly cultured organisms were P. aeruginosa followed by S. epidermidis. All suspected infections were treated with broad spectrum parenteral antibiotics with MRSA coverage. The most common combination was daptomycin 6 mg/kg combined with Zosyn 4.5 g. Explantations were significantly more common in patients with history of chemotherapy (p = 0.03), hypertension (p = 0.04) and those who underwent therapeutic mastectomy (p = 0.04).

Conclusion

Risk factors for explantation due to postoperative periprosthetic infections following TE/implant-based breast reconstruction include chemotherapy, hypertension and therapeutic mastectomy. Prompt diagnosis and effective treatment of periprosthetic infection, particularly in these high-risk patients, are imperative to salvage the breast reconstruction. Gram-negative bacteria are increasingly found in breast implant infections and should be covered when employing empiric antibiotherapy.

Level of Evidence IV

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Authors and Affiliations

  1. Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA

    Can Ozturk, Cemile N. Ozturk, Mary Platek, Allison Soucise, Robert Lohman & Wong Moon

  2. Division of Plastic and Reconstructive Surgery, Loyola University Medical Center, 2160 S. 1st Ave., Maywood, IL, 60153, USA

    Peter Laub

  3. Cleveland Clinic, 1 Akron General Ave., Akron, OH, 44307, USA

    Nabiha Morin

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  1. Can Ozturk
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  2. Cemile N. Ozturk
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Correspondence to Can Ozturk.

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Conflicts of interest

The authors declare that they have no conflicts of interest to disclose. Author Robert Lohman is a designer, consultant, shareholder and patent holder for Vioptix Inc. Instruments made by Vioptix were not used for this study.

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This article does not contain any studies with human participants or animals performed by any of the authors as it was a retrospective chart review.

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For this type of study, informed consent is not required.

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Ozturk, C., Ozturk, C.N., Platek, M. et al. Management of Expander- and Implant-Associated Infections in Breast Reconstruction. Aesth Plast Surg 44, 2075–2082 (2020). https://doi.org/10.1007/s00266-020-01923-8

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  • DOI: https://doi.org/10.1007/s00266-020-01923-8

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