Salvage of the exposed breast implant

Exposure of silicone breast implants may occur as a result of hematoma and infection, inadequate soft tissue coverage, use of steroids, or trauma. In various series the incidence of severe complications is reported to range from 1% to 4%. When exposure of the implant has occurred, most authors recommend removal with replacement four to six months later. In 11 patients we successfully salvaged the exposed breast implant. The technique was initially presented in 5 patients in 1974. Successful salvage of the exposed implant involved (1) wound cultures with preoperative and postoperative antibiotic therapy, (2) excisional debridement of the skin wound, (3) open capsulotomy to relieve tension, (4) wound irrigation with neomycin-polymyxin or povidone-iodine, (5) closed catheter drainage, and (6) replacement with a sterile prosthesis. Secondary closure of these wounds was successful in all of the patients. Of the 11 patients, 9 were seen at two years postoperatively with results comparable in appearance and softness to the opposite breast. One of the patients required subsequent bilateral capsulotomies for firmness. The use of this technique is recommended for selected patients in whom there are no systemic problems related to wound healing and in whom sufficient soft tissue coverage is possible.