One-Step Salvage of Infected Prosthetic Breast Reconstructions Using Antibiotic-Impregnated Polymethylmethacrylate...

Area of Science:

• Plastic Surgery
• Infectious Disease
• Biomaterials

Background:

• Periprosthetic infection is a common complication in breast reconstruction, often resulting in expander-implant loss.
• Current management strategies for infected breast prostheses have variable success rates.
• A standardized protocol for managing infected breast implants is lacking.

Purpose of the Study:

• To evaluate the early outcomes of a novel protocol for salvaging infected breast implants.
• The protocol involves antibiotic-impregnated polymethylmethacrylate (PMMA) implant placement with expander device exchange.

Main Methods:

• Retrospective analysis of patients with infected implant-based breast reconstruction undergoing salvage.
• Protocol included IV antibiotics, surgical debridement, PMMA implant/bead insertion, device exchange, and postoperative antibiotics.
• Tissue expansion proceeded after infection resolution, with PMMA implants remaining until permanent implant exchange.

Main Results:

• Successful implant pocket sterilization was achieved in all patients.
• No reoperations for capsular contracture were required at a mean follow-up of 8.2 months.
• One case of recurrent infection occurred during prednisone treatment; two patients tolerated radiation therapy without complications.

Conclusions:

• Sustained local antibiotic delivery via PMMA implants and expander exchange effectively salvages infected breast implants.
• Benefits include accelerated reconstruction, preserved skin envelope, and potentially enhanced aesthetic results.
• This approach offers a promising strategy for managing periprosthetic infections in breast reconstruction.