A Cohort Study of Immediate Implant Exchange During Acute Infection in the Setting of Breast Reconstruction

Publication date: Available online 8 April 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Shailesh Agarwal, Russell E. Ettinger, Theodore A. Kung, Jeffrey H. Kozlow, David L. Brown
BackgroundImplant infections in the setting of breast reconstruction present a significant setback for breast cancer patients. Traditional management of implant infections is predicated on operative removal of the implant and delayed replacement. Another option for implant infection management has emerged in which the soft tissue infection is neutralized, the implant is removed and the surgical site washed out, and a new implant replaced immediately. Here we present our findings with the implementation of this technique and an algorithm for choosing which patients are the most appropriate candidates based on retrospective review.MethodsA retrospective chart review was performed at the University of Michigan of patients who underwent operative removal of infected expanders from January 1, 2010 to December 31, 2015 by the senior authors. Final reconstructive outcome, time to reconstruction, and infection recurrence were evaluated.ResultsA total of twenty patients with clinical signs of implant infections were identified. Sixteen of twenty patients with clinical signs of implant infection underwent immediate implant exchange. Fifteen patients remained infection-free, while one patient developed recurrent infection within one month, which was treated with device removal. Mean time to final reconstruction in the 15 patients who remained infection-free was 207 days while the four patients who underwent removal without immediate replacement had a 75% rate of non-completion at over 500 days.ConclusionsOur findings demonstrate that immediate implant exchange safely offers patients the opportunity to remain on a path towards reconstruction. These findings offer support for a paradigm shift in our management of implant infections in breast reconstruction patients who already face challenges associated with breast cancer care.



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