Follow-Up Study: One-Step Salvage of Infected Prosthetic Breast Reconstructions Using Antibiotic-Impregnated...

Area of Science:

• Plastic Surgery
• Infectious Disease
• Biomaterials

Background:

• Periprosthetic infections are a significant complication in breast reconstruction, often resulting in the loss of expander-implants.
• A standardized management algorithm for attempting to salvage infected breast prostheses is currently lacking.
• This study evaluates a specific salvage protocol involving antibiotic-impregnated polymethylmethacrylate (PMMA) implants and expander device exchange.

Purpose of the Study:

• To assess the efficacy and outcomes of a salvage protocol for severe prosthetic infections in breast reconstruction.
• To compare the success rates of prosthetic salvage versus traditional explantation in infected cases.
• To evaluate the impact of the salvage protocol on the completion of final breast reconstruction.

Main Methods:

• A retrospective review of 626 breast reconstruction cases between 2009 and 2017 identified 62 with severe prosthetic infections.
• Forty-five patients underwent the salvage protocol: intravenous antibiotics, surgical débridement, PMMA plate insertion, device exchange, and postoperative antibiotics.
• Seventeen patients underwent immediate explantation for comparison.

Main Results:

• The salvage protocol achieved a primary infection clearance rate of 82.2% (37 out of 45 patients).
• Significantly more salvage patients completed final reconstruction (84.4%) compared to the explantation group (35.3%; p < 0.001).
• Fewer patients abandoned reconstruction after salvage (2.2%) versus explantation (58.8%; p < 0.001).

Conclusions:

• Sustained local antibiotic delivery via PMMA implants and device exchange effectively salvages infected breast expanders/implants.
• The salvage approach leads to higher rates of final reconstruction completion compared to explantation.
• Benefits include preservation of the skin envelope and potentially improved long-term aesthetic results.