Reducing the burden of breast implant infections through a structured multidisciplinary pathway

Breast implant-related infections are major complications of implant-based breast reconstruction, leading to implant loss, delays in adjuvant oncologic therapies, prolonged hospitalization, and increased healthcare costs. Despite their impact, management strategies remain heterogeneous, and evidence supporting structured preventive approaches is limited. This study evaluated the effect of a structured multidisciplinary pathway (CONMUL) on infection incidence and clinical outcomes.

A single-center retrospective cohort study included patients who underwent mastectomy followed by implant-based breast reconstruction between January 2022 and December 2025. From January 2024, a multidisciplinary protocol integrating plastic surgeons and infectious disease specialists was progressively implemented, including standardized preventive measures, early specialist consultation, and shared management pathways. The primary outcome was the trend in postoperative infection incidence before and after CONMUL implementation. Secondary outcomes included explantation rates, implant salvage, reinfection, and time to explantation.

Overall, 927 patients (1102 reconstructed breasts) were included, and 98 breasts (8.9%) developed postoperative infection. Annual infection incidence peaked at 11.42% in 2023 and declined following CONMUL implementation, reaching 5.15% in 2025, corresponding to approximately 15 fewer infections per year. Once infection occurred, explantation remained the most frequent outcome, with no significant differences between multidisciplinary and standard management. Time to explantation and reinfection rates were comparable between groups.

A structured multidisciplinary pathway was associated with a clinically meaningful reduction in postoperative breast implant infection incidence. While multidisciplinary management did not significantly change outcomes after infection onset, it functioned as an effective preventive, system-level strategy without compromising clinical safety.