Analysis of clinical management of infected breast implants and of factors associated to successful breast pocket salvage in infections occurring after breast reconstruction

Objectives: Considerable efforts have been devoted so far to improve salvage procedures of infected breast implants in absence of defined guidelines or validated clinical protocols. Within a cohort of prospectively recruited patients who underwent breast reconstruction, we performed a retrospective review of proven implant infections in order to describe factors contributing to management success. Methods: We collected data in 1293 consecutive patients who underwent two stage (expander + prosthesis) breast reconstruction with at least 12 months of follow-up. Demographic data, timing of infection, type of microorganism, intent of salvage, fate of the implant, type of antibiotic treatment and follow-up were recorded in a prospective data collection on clinical records. Results: Implant infections occurred in 103 of 1293 patients (8%). Among these, 73 (71%) were proven infections with confirmed microbiology. Implant pocket salvage was attempted in 43/73 (59%). patients A higher proportion of expander implant pockets were successfully saved compared to prosthetic pocket (p = 0,04). Gram-positive microrganisms represented the majority of etiologic agents, with coagulase negative staphylococci prevailing over Staphylococcus aureus. No association was observed between success rate and type of infecting microorganism. A higher proportion of patients with previous or intraoperative radiotherapy or with perioperative chemotherapy underwent an attempt of implant salvage (p = 0,081 and 0,0571 trend, respectively). No single antibiotic regimen was superior to the others in terms of success rate. Implant pocket salvage was higher in expanders compared to prostheses (74% vs 33% p = 0,04). Higher success rates in implant pocket salvage were evident when implant replacement was preceded and followed by antibiotic treatment compared to inpatient antibiotic treatment alone (100% versus 57%, p = 0,035). Conclusion: Patient selection in clinical practice leads to differences in patients with breast implant infection who are considered for attempts at implant salvage vs. those who are treated with implant removal. Salvage of breast implant pockets can be obtained in the majority of patients with combined one-step implant replacement surgery and antibiotic treatment. Increased efforts and protocols to recruit patients into pocket salvage management are needed. © 2018 The Authors AUTHOR KEYWORDS: Antibiotic treatment; Breast implant infection; Breast surgery INDEX KEYWORDS: beta lactam antibiotic; cefazolin; clindamycin; cotrimoxazole; daptomycin; levofloxacin; polypeptide antibiotic agent; rifampicin, adult; antibiotic prophylaxis; antibiotic therapy; Article; breast pocket salvage; breast reconstruction; cellulitis; coagulase negative Staphylococcus; combination drug therapy; comparative study; controlled study; follow up; Gram negative infection; Gram positive bacterium; hospital patient; human; intraoperative radiotherapy; major clinical study; mastectomy; methicillin resistant Staphylococcus aureus infection; methicillin susceptible Staphylococcus aureus; middle aged; perioperative period; prosthesis infection; retrospective study; salvage therapy; Staphylococcus infection