Management of the Exposed and/or Infected Breast Prosthesis: A Proposal for a Standardized Approach

Abstract

BACKGROUND Implant infection and exposure are the main complications related to breast reconstructive and aesthetic surgery. 1,2 In the past, treatment was immediate device removal with implant repositioning no earlier than 6 months. Recently, numerous successful attempts of device salvage have been reported. 3,4 There is still disagreement about the indications and the procedures. 5 We propose the protocol adopted at Bellaria Hospital of Bologna for device salvage. METHOD Complications were classified as follows: local implant infection responsive to oral antibiotics, persistent infection (more than 7 days), and partial exposure with or without infection. The severity of infection was an important factor in deciding whether or not to attempt to salvage. Oral antibiotics (amoxicillin + clavulanate and trimetoprim + sulfametoxazol/clindamycin) were given in case of initial infection for 7 days. In case of persistent infection or in case of partial implant exposure, intravenous antibiotics (piperacillin + tazobactam/ampicillin + sulbactam and vancomycin/teicoplanin) were administered for at least 10 days and immediate surgical operation was performed. Operative steps included wound cultures collection; implant removal; pulse lavage; capsulectomy; and device exchange for the same type of implant in augmentation mammoplasty or for a smaller and less projected prosthesis in reconstructive surgery, primary closure, or capsular flaps in case of exposure. Inflammatory markers were evaluated at admission and in postoperative days 1, 3, 5, and 7. Targeted IV antibiotics were continued after surgery. RESULTS We report 2 cases of successful device salvage following this protocol. The first case, a 54-year-old woman, underwent right mastectomy and prosthetic breast reconstruction; 3 years after surgery, she presented with implant infection. The second case, a 32-year-old woman, underwent periareolar augmentation mammoplasty. After 2 years, she presented with a right implant exposure (Figs. 1, 2). Both patients were treated following our protocol (Fig. 3). No complications were observed after 6 and 12 months, respectively. Fig. 1. Implant exposure 2 years after periareolar augmentation mammoplasty. Fig. 2. Details of the implant exposure. Fig. 3. Result 12 months after the application of our protocol. CONCLUSION In our experience, device salvage is a possible option in selected cases, adopting a well-defined approach. Our purpose is to apply this protocol to a further prospective study, expanding the cohort of patients and providing long-term results of this method.