Prosthesis salvage in breast reconstruction patients with periprosthetic infection and exposure.

摘要

BACKGROUND: Breast prosthesis reconstruction continues to be the most common form of breast reconstruction, and infection and exposure remain major concerns for patients and surgeons. METHODS: A retrospective review was performed of patients who underwent attempted implant salvage between 2002 and 2008 by a single surgeon according to a single protocol. Analyzed data include detailed patient demographics, clinical and laboratory findings, and outcomes. RESULTS: Sixty patients were identified who had been taken to the operating room secondary to infection and/or exposure of a breast prosthesis. Seventeen underwent removal of the prosthesis without attempted salvage and 43 patients underwent attempted salvage. Successful attempted salvage occurred in 76.7 percent of cases, with a mean follow-up of 18.4 months (range, 1 to 60 months). Staphylococcus epidermidis led to a statistically higher rate of failed salvage (25 percent versus 0 percent, p = 0.04). Of the 33 patients who had successful salvage of the prosthesis, two developed capsular contracture (6 percent). CONCLUSIONS: Intervention should be prompt and aggressive, and should implement a combination of surgical and antimicrobial therapies. The data from the authors' results provide additional tools for patient selection and treatment, and offer a simplified management protocol for breast reconstruction patients with infected and/or exposed breast prostheses. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.