Surgeons' Dilemma: Treatment of Implant-Associated Infection in the Cosmetic Breast Augmentation Patient.

[BACKGROUND] Augmentation mammaplasty is the most common plastic surgical procedure performed in the USA. 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 and Cochrane databases were searched through February 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. There was inconsistency in the reporting of several key factors, such as the antibiotic regimens employed, culture sensitivities, time from diagnosis to treatment, implant characteristics, as well as the precise treatment of the capsule and pocket. A total of 58 implants were treated, of which 37 (63.8%) were exposed in the setting of infection and 21 (36.2%) were infected without exposure. One-stage implant salvage was employed in 31 implants and was successful in all. The capsular contracture rate with this approach was 6.5%. 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%, 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%).

[CONCLUSIONS] The inconsistency and paucity of the data in the literature preclude definitive conclusions with regard to the optimal management of the threatened implant following augmentation mammaplasty. Given the excellent salvage rates in this setting, a more prominent role and liberal utilization of implant salvage are proposed.

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