Surgeons' dilemma: treatment of implant associated infection in the cosmetic breast augmentation patient.
Vasileios Vasilakis, MD, Richard G. Reish, MD, FACS.
Long Island Plastic Surgical Group, Garden City, NY, USA.
BACKGROUND: Augmentation mammaplasty is the most common plastic surgical procedure performed in the United States. The management of severe implant associated infection is a challenge and the traditional two-stage treatment is associated with significant limitations. The aim of this literature review is to provide a comprehensive analysis of all studies dealing with the management of severe infection or implant exposure following cosmetic breast augmentation.
METHODS: The PUBMED database was searched through February of 2018 for studies on the management of severe infection and threatened or actual implant exposure following primary augmentation mammaplasty. Search terms used were “breast implant”, “breast prosthesis”, “breast augmentation”, “breast augmentation complications”, “infected implant”, “implant salvage” and “implant exposure”.
RESULTS: Five articles met inclusion criteria. A total of 61 implants were treated, of which 37 (40.6 percent) were exposed in the setting of infection, 21 (36.5 percent) were infected without exposure, and 3 (4.8 percent) were exposed in the absence of infection. One-stage implant salvage was employed in 34 implants, and was successful in all. Capsular contracture rate in this approach was 5.9 percent. Antibiotic-alone, non-operative, treatment was employed in the salvage of 22 implants, with success and capsular contracture rates of 77.3 and 13.6 percent respectively. In the setting of severe periprosthetic infection in the absence of implant exposure, antibiotic-alone treatment was successful in the salvage of 13 out of 14 implants (92.9 percent).
CONCLUSIONS: Salvage rates of the infected or exposed implant following cosmetic augmentation mammaplasty are significantly higher than those reported in the setting of implant breast reconstruction. A more aggressive approach in terms of implant salvage, even in the most severe forms of implant compromise, is worthwhile.
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