Management of the infected or exposed breast prosthesis: a single surgeon's 15-year experience with 69 patients.

BACKGROUND: In 2004, the senior author (S.L.S.) published an algorithm for the management of breast device infection and/or exposure. The purpose of this study was to build on the authors' prior experience by expanding the cohort of patients and to identify risk factors for failed breast device salvage and recurrent infection/exposure.
METHODS: A retrospective study was carried out on a single plastic surgeon's experience between 1993 and 2008. Patients with infected and/or exposed breast devices were classified into one of seven groups and salvage rates were calculated. Patient demographics and wound culture pathogens were analyzed as possible risk factors for device loss and recurrent infection/exposure.
RESULTS: Over a 15-year period, the senior author managed 69 patients with 87 events of breast device infection and/or exposure. The overall salvage rate was 64.4 percent. Failed device salvage was significantly associated with the presence of atypical pathogens, such as gram-negative rods, methicillin-resistant Staphylococcus aureus, and Candida parapsilosis. Recurrent device infection and/or exposure was significantly associated with a history of radiotherapy or the presence of S. aureus on wound culture.
CONCLUSIONS: Salvage of the infected and/or exposed breast prosthesis remains a challenging yet viable option for a subset of patients. Relative contraindications include atypical pathogens on wound culture, such as gram-negative rods, methicillin-resistant S. aureus, and C. parapsilosis. Patients with a prior device infection and/or exposure and a history of either radiotherapy or S. aureus on wound culture should be monitored closely for signs of recurrence and managed cautiously in the setting of elective breast surgery.