Dominykas Markevičius¹,  Nerijus Jakutis^2,3

¹ Faculty of Medicine, Vilnius University, Vilnius, Lithuania.

² Clinic of Rheumatology, Orthopedics – Traumatology and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania

³ Center of Plastic Reconstructive Surgery, Vilnius University Hospital “Santaros Klinikos”, Vilnius, Lithuania

Abstract

Review purpose: To describe and compare the risk factors of postoperative breast implant infection after breast reconstruction and to present the latest diagnostic and surgical treatment approach described in the scientific literature.

Methods: Detailed literature review of articles published in 2002-2019 was performed using PubMed, Researchgate data bases and Google Scholar search system. Keywords used in the search: breast implant infection, risk factors, breast salvage, diagnostics, surgical methods.

Results: About 80% of all breast reconstruction procedures after mastectomy are implant-based. The overall rate of infections associated with breast reconstruction is 1-35%. The most common infection risk factors were smoking, obesity, arterial hypertension, diabetes mellitus, hypercholesterolemia, larger than C cup size breasts, and various conditions compromising the immune system. The risk of postoperative infection was also increased by radiotherapy (4,88 times) and chemotherapy. Diagnostics involve clinical manifestation, periprosthetic fluid aspiration with microbiology and ultrasound. Implant removal and breast reconstruction with autologous tissue has been so far the most popular treatment, although the implant salvage procedure with perioperative antibiotic therapy has gained more popularity, with a success rate reaching 92.9%.

Conclusions: The main risk factors for breast implant infection are smoking, obesity, arterial hypertension, diabetes mellitus, hypercholesterolemia, larger than C cup size breasts, and various immune system compromising conditions. Diagnostics involve clinical manifestation, periprosthetic fluid aspiration with microbiology and ultrasound. The surgical treatment approach described in the literature vary, so it is important to choose the right treatment based on the clinical features, surgical experience, and the factors leading to the lowest complication rate.

Keywords: Breast implant, breast implant infection, breast reconstruction, breast salvage.