Late infection following breast augmentation with textured silicone gel-filled implants

Infection after insertion of a breast prosthesis is an uncommon but feared complication. Previously reported infection rates vary and include reconstructive and cosmetic patients.

We sought to define the infection rate and the presentation of postoperative infection in the patient with aesthetic breast augmentation.

A prospective analysis was undertaken of 288 patients who underwent aesthetic breast augmentation with textured silicone gel-filled implants between 1998 and 2002. Patients were monitored for clinical findings of infection, and microbiological analyses were performed for each case of infection. "Early infection" was defined as signs and symptoms of infection beginning 20 days or less post-surgery; "late infection" was defined as all cases with an onset more than 20 days post-surgery. Treatment was classified as antibiotic therapy only, conservative surgical intervention (with or without implant salvage), or implant explantation and replacement.

Early infectious complications occurred in 6 of 288 women (2.08%). Late infection complications occurred in 10 of 288 women (3.47%). Late infection occurred more often and was more severe than early infection (P < .05). For the late infection group, the length of time to infection onset was between 20 and 280 days (average, 82 days). The length of time to infection was shown to be bimodal and organism-related. The group of infections caused by Enterobacter species had a significantly longer time of onset (P < .05) than the group caused by Staphylococcus aureus.

There is strong evidence that late infections can occur in patients who have undergone aesthetic breast augmentation using textured silicone gel-filled implants. Further studies are needed to determine whether similar late infection rates affect patients with aesthetic breast augmentation who receive saline-filled implants.