Redefining infection management in implant-based breast reconstruction: Insights and innovations from an 11-year retrospective analysis

Background

Infections associated with implant-based breast reconstructive surgery are challenging for both patients and surgeons, often implying high recurrence rate, long treatments (both medical and surgical management), multiple invasive procedures, and delay of the end-result and, in some cases, even reconstruction failure. Early diagnosis is crucial but not always easy to achieve. Various treatment options are available and have been described in literature, with no clear winning strategy. Recent improvements in microbiological and therapeutic tools have led the authors to question what would be considered the best plan for reconstruction salvage approach.

Methods

All patients who underwent implant-based breast reconstruction between 2012 and 2023 were enrolled. Clinical records regarding infections and treatment were retrospectively analyzed.

Results

Among a total of 506 patients, 26 (5.14%) developed implant-associated infections. Discussing the results, we realized that previous protocol was old-fashioned and required improvements. Through a multidisciplinary approach, a new prevention and treatment algorithm was derived. First, microbiological screening through nasal and rectal swab allows for proper decontamination prior to intervention. However, the keystone improvement consists in the use of molecular biology analysis, thus minimizing diagnosis timing and allowing targeted antibiotic therapy shortly after the removal of the infected implant. In addition, a fundamental role is played using instillation negative pressure wound therapy as a temporary spacer to ensure the maintenance of the periprosthetic pocket.

Conclusions

By following these precise steps in case of implant-associated infection, treatment can be optimized to reduce both therapy and hospitalization time, allowing the patient to achieve a reconstruction in a relatively short period.

Level of evidence

IV