Periprosthetic infection and salvage of breast implant after primary breast augmentation

Abstract

Introduction: Breast implants are one of the most popular types of plastic surgery prostheses. Periprosthetic infection is one of the major complications that often results in implant loss. It is much more common in oncoplastic patients after breast reconstruction compared to patients after primary breast augmentation with implants. There is still a debate regarding various techniques and the clinical management of periprosthetic breast infection. This case report presents successful salvage of breast prosthesis. Case description: A 29-year old woman presented with a 3x2mm size lesion of postoperative scar. Further inspection revealed that the wound was deep, went through all the layers of the breast and the implant was exposed in the wound bed. There were no other clinical signs of infection except of wound desistance, granulation tissue in the subcutaneous layer and swelling around the wound. Medical history revealed that the patient had undergone breast augmentation with silicone gel prosthesis 6 weeks ago, postoperative period was fluent until the incidence. The patient informed that she was on holiday the previous week, was using sauna and swimming in a lake, subsequently she noticed a wound in the left breast and copious yellow exudate. An infection of the implant was suspected, and revision surgery was advised. The revision surgery under general anaesthesia was done the following day after examining the patient. A prophylactic dose of cefuroxime was given. The postoperative scar with inflamed surrounding tissue was excised and the implant was removed. Prosthesis was mechanically cleaned and immersed in 0.9 percent NaCl solution, 1 g of cefazolin, 80 mg of gentamicin,1 g of clindamycin and 50% Betadine solution, the exposure time was 30 minutes. During the surgery the implant socket was revised, there was no purulent exudate, thus the decision to save the implant was made. The pocket was irrigated with the same solution as the implant, a vacuum drain was inserted. The prosthesis was reimplanted, and the wound was closed. After the surgery patient was treated with 7-dayantibiotic therapy of cefuroxime and metronidazole. The wound bacterial culture came back negative. Postoperative recovery was uneventful and there were no further complications. Conclusions: The described case report showcases 1-stage periprosthetic infection management and implant salvage using rigorous implant and breast pocket cleaning along with antibiotic therapy. The method used in this case can yield positive results and allow salvage of the implant when non-severe implant infection occurs early after breast augmentation.