Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Strategy for salvaging infected breast implants: lessons from the recovery of seven consecutive patients

  • Yeo, Hyeonjung (Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital) ;
  • Lee, Dongkyu (Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital) ;
  • Kim, Jin Soo (Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University) ;
  • Eo, Pil Seon (Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University) ;
  • Kim, Dong Kyu (Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University) ;
  • Lee, Joon Seok (Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University) ;
  • Kwon, Ki Tae (Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Lee, Jeeyeon (Department of Surgery, School of Medicine, Kyungpook National University) ;
  • Park, Ho Yong (Department of Surgery, School of Medicine, Kyungpook National University) ;
  • Yang, Jung Dug (Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University)
  • Received : 2020.08.10
  • Accepted : 2020.12.13
  • Published : 2021.03.15
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Abstract

Background In recent years, implant-based breast reconstruction has been performed because of its simplicity, short operation time, and rapid recovery of patients. Several studies have reported treatment methods for implant surgery-related infection, which is a serious complication. The aim of this study was to introduce our strategy for salvaging infected implants and to evaluate its effectiveness. Methods The authors performed a retrospective study of 145 cases from 132 patients who underwent implant-based breast reconstruction from January 2012 to December 2018. Empirical antibiotics were immediately administered to patients with suspected infections. The patients then underwent salvage treatment including appropriate antibiotics, ultrasonography-guided aspiration, debridement, antibiotic lavage, and implant exchange through a multidisciplinary approach. Patient demographics, operative data, duration until drain removal, adjuvant treatment, and complications were analyzed. Results The total infection rate was 5.5% (8/145). A longer indwelling catheter period and adjuvant treatment were significantly associated with infection. The salvage treatment showed a success rate of 87.5% (7/8). Seven patients who received early aggressive salvage treatment recovered from infection. One patient with methicillin-resistant Staphylococcus aureus, who received salvage treatment 11 days after symptom onset, did not respond to drainage and antibiotic treatment. That patient subsequently underwent explantation. Conclusions In implant-based breast reconstruction, prevention of infection is of the utmost importance. However, if an infection is suspected, proactive empirical antibiotic therapy and collaboration with the necessary departments are required. Through a multidisciplinary approach and proactive early management, swift and appropriate salvage should be performed.

Keywords

References

  1. American Society of Plastic Surgeons (ASPS). 2018 Plastic surgery statistics report [Internet]. Arlington Heights, IL: ASPS; c2019 [cited 2021 Mar 9]. Available from: Available at: https://www.plasticsurgery.org/documents/News/Statistics/2018/plastic-surgery-statistics-full-report-2018.pdf.
  2. Brown MH, Shenker R, Silver SA. Cohesive silicone gel breast implants in aesthetic and reconstructive breast surgery. Plast Reconstr Surg 2005;116:768-79. https://doi.org/10.1097/01.prs.0000176259.66948.e7
  3. Kim JB, Jeon HJ, Lee JW, et al. A murine model of radiationinduced capsule-tissue reactions around smooth silicone implants. J Plast Surg Hand Surg 2018;52:217-24. https://doi.org/10.1080/2000656X.2018.1444617
  4. Araco A, Gravante G, Araco F, et al. A retrospective analysis of 3,000 primary aesthetic breast augmentations: postoperative complications and associated factors. Aesthetic Plast Surg 2007;31:532-9. https://doi.org/10.1007/s00266-007-0162-8
  5. Sullivan SR, Fletcher DR, Isom CD, et al. True incidence of all complications following immediate and delayed breast reconstruction. Plast Reconstr Surg 2008;122:19-28. https://doi.org/10.1097/PRS.0b013e3181774267
  6. Cordeiro PG, McCarthy CM. A single surgeon's 12-year experience with tissue expander/implant breast reconstruction: part I. a prospective analysis of early complications. Plast Reconstr Surg 2006;118:825-31. https://doi.org/10.1097/01.prs.0000232362.82402.e8
  7. De Cholnoky T. Augmentation mammaplasty: survey of complications in 10,941 patients by 265 surgeons. Plast Reconstr Surg 1970;45:573-7. https://doi.org/10.1097/00006534-197006000-00007
  8. Warren Peled A, Itakura K, Foster RD, et al. Impact of chemotherapy on postoperative complications after mastectomy and immediate breast reconstruction. Arch Surg 2010;145:880-5. https://doi.org/10.1001/archsurg.2010.163
  9. Leyngold MM, Stutman RL, Khiabani KT, et al. Contributing variables to post mastectomy tissue expander infection. Breast J 2012;18:351-6. https://doi.org/10.1111/j.1524-4741.2012.01253.x
  10. Chun JK, Schulman MR. The infected breast prosthesis after mastectomy reconstruction: successful salvage of nine implants in eight consecutive patients. Plast Reconstr Surg 2007;120:581-9. https://doi.org/10.1097/01.prs.0000270296.61765.28
  11. Prince MD, Suber JS, Aya-Ay ML, et al. Prosthesis salvage in breast reconstruction patients with periprosthetic infection and exposure. Plast Reconstr Surg 2012;129:42-8. https://doi.org/10.1097/PRS.0b013e3182361fbd
  12. Lee JS, Kim JS, Lee JH, et al. Prepectoral breast reconstruction with complete implant coverage using double-crossed acellular dermal matrixs. Gland Surg 2019;8:748-57. https://doi.org/10.21037/gs.2019.12.10
  13. Alderman AK, Wilkins EG, Kim HM, et al. Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg 2002;109:2265-74. https://doi.org/10.1097/00006534-200206000-00015
  14. Gabriel SE, Woods JE, O'Fallon WM, et al. Complications leading to surgery after breast implantation. N Engl J Med 1997;336:677-82. https://doi.org/10.1056/NEJM199703063361001
  15. Spear SL, Seruya M. Management of the infected or exposed breast prosthesis: a single surgeon's 15-year experience with 69 patients. Plast Reconstr Surg 2010;125:1074-84. https://doi.org/10.1097/PRS.0b013e3181d17fff
  16. Courtiss EH, Goldwyn RM, Anastasi GW. The fate of breast implants with infections around them. Plast Reconstr Surg 1979;63:812-6. https://doi.org/10.1097/00006534-197963060-00006
  17. Reish RG, Damjanovic B, Austen WG Jr, et al. Infection following implant-based reconstruction in 1952 consecutive breast reconstructions: salvage rates and predictors of success. Plast Reconstr Surg 2013;131:1223-30. https://doi.org/10.1097/PRS.0b013e31828bd377
  18. Trop I, Dugas A, David J, et al. Breast abscesses: evidence-based algorithms for diagnosis, management, and follow-up. Radiographics 2011;31:1683-99. https://doi.org/10.1148/rg.316115521
  19. Schlarb D, Idelevich EA, Krause-Bergmann A, et al. Successful interdisciplinary radical treatment of Mycobacterium fortuitum infection in a lipotourist from Germany after abdominoplasty in Turkey. New Microbes New Infect 2015;8:21-3. https://doi.org/10.1016/j.nmni.2015.09.003
  20. Feldman EM, Kontoyiannis DP, Sharabi SE, et al. Breast implant infections: is cefazolin enough? Plast Reconstr Surg 2010;126:779-85. https://doi.org/10.1097/PRS.0b013e3181e5f7ff
  21. Song JH, Kim YS, Jung BK, et al. Salvage of infected breast implants. Arch Plast Surg 2017;44:516-22. https://doi.org/10.5999/aps.2017.01025
  22. Yii NW, Khoo CT. Salvage of infected expander prostheses in breast reconstruction. Plast Reconstr Surg 2003;111:1087-92. https://doi.org/10.1097/01.PRS.0000046490.02212.BA