Management of Infection following Breast Reconstruction Using a Prosthesis

― Can Infection Be Controlled by Salvage without Removal ? ―

Abstract

In breast reconstruction by prosthesis, several management methods have been reported and argued in case of prosthesis infection. We have accordingly devised different methods for infection.

We examined cases of infection following breast reconstruction by prosthesis for 15 years to determine the appropriate management method for prosthesis infection. Over these 15 years, 70% of cases of expander infection were salvaged without removal (mild infection, 100% ; severe infection, 45.4%) . For silicone implant infections, 88.2% of cases were salvaged (mild infection, 100% ; severe infection, 81.8%) .

For severe infections, there was a difference between the expander and silicone implants.

We performed salvage in four ways : (1)antibiotics only, (2)retrograde irrigation through drainage tube + antibiotics, (3)wound drainage + antibiotics, and(4)capsule debridement/ retention of prosthesis after irrigation + antibiotics.

There was a significant difference in the successful salvage rate by wound drainage between expander and silicone implant infection (p = 0.043) . This is the cause of the difference in salvage rate. No significant risk factors were found to be associated with salvage failure. Our data suggest that controlling prosthesis infection is possible without removal.