Infection of mammary prostheses: a survey and the question of prevention

Seventy-three plastic surgeons reported 60 early and late mammary implant infections among 54,661 implantations. Smooth, textured, and polyurethane-coated implants had similar infections rates (respectively, 0.06%, 0.16%, and 0.12% for augmentations and 0.6%, 0.4%, and 0.3% for reconstructions including revisions and expansions). Insertion routes and implant placements had no influence on infection rates. Causative bacteria included Staphylococcus aureus and S. epidermidis, Streptococci A and B, enterobacteria, Klebsiella, Pseudomonas, and mycobacteria. Most surgeons followed a regimen of topical and/or systemic prophylaxis. Some (approximately 20%) used the Dolsky insertion sleeve. Whereas smoking, obesity, and diabetes did not significantly predispose to infection, the following did: skin atrophy and scarring, corticosteroids in subglandular augmentation, additional simultaneous surgery, pregnancy, preceding lactation, and vigorous exercising, massage, and trauma postsurgically. Few late implant infections were recorded resulting from bacterial milk duct invasion or hematogenously from antecedent infection foci. The need for and the possibilities of preventive measures are critically discussed.