Dominykas Markevičius1, Nerijus Jakutis2,3
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.
Introduction: Breast implant infection is the most common complication after breast reconstruction surgeries. A lot of different implant infection management protocols exist, and they are still debatable which is the best. We present the case of a patient with breast implant infection after risk-reducing bilateral mastectomy with immediate direct-to-implant reconstruction.
Case presentation: A 45-year-old woman underwent bilateral prophylactic mastectomy with immediate implant reconstruction. 31 days after the discharge she was administered to an emergency department with painful, erythematous non-healing wound in left breast. During the examination, a 2 cm wound covered with necrotic masses was observed. During the debridement surgery, a deeper implant-reaching necrosis was revealed. Immediate surgery involving debridement, lavage with antiseptics, defect closure was performed. A day after, the patient complained of left breast redness and enlargement. Despite no leukocytosis or elevated CRP, breast implant infection was diagnosed. Implant salvage procedure was indicated, during which partial capsulectomy and temporal explantation were performed, a swab for microbiological culture taken. The implant was irrigated with saline and povidone – iodine solution, then placed in a povidone – iodine-based solution with gentamicin (80.0 g) and cefazoline (1.0 g) 1.5 hours. After thorough debridement and implant pocket irrigation with 50 % povidone – iodine and antibiotic solution the same implant was reimplanted. Cefuroxime was administered and the drain was taken out after 5 days. 7 days after the surgery the patient was discharged without any signs of infection.
Conclusions: Breast implant infection remains one of the most dreaded complications after breast reconstruction surgery. We could not find any publication about the reimplantation of the same implant during the implant salvage procedure. Our case shows that a new breast implant salvage protocol could be used successfully in order to salvage the infected breast implant.
Keywords: Breast implant infection, breast reconstruction, implant salvage procedure.