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BREAST REVISION RECONSTRUCTION AFTER EXPLANTATION OF IMPLANT FOR INFECTION

The second most common complication after bleeding in breast augmentation surgery is infection. Infection has to be treated effectively and efficiently. If the patient has contamination or infection of an implant, most of the time explantation (removal of the implant) will be required in order to allow that breast to heal. It is difficult for the body to heal an area where there is a prosthetic device with concurrent infection or contamination. This not only includes breast implants, but also includes heart valves, hip replacements and shunts within the brain. Anytime there is a prosthetic device, the body will try to wall that of by creating a capsule. If, however, a form of infection should arise in that area, it is very difficult for the body to heal that area without removal of that prosthetic device. In the best of all worlds, we try to prevent having to reconstruct the breast after an augmentation by preventing infection off the bat. Therefore, when the patient has her original surgery, we try all attempts to prevent infection, although it is not always 100% possible.

Prophylactic antibiotics given intravenously are very useful. Intravenous Ancef and now even possibly Vancomycin, are drugs of choice in order to reduce staph and strep infections, which are the most common infection of a breast implant.

Postoperative antibiotics are also given. We prefer 750 mg of Keflex, twice a day, for one week or possibly Ciprofloxacin 500 mg twice a day or Levaquin, 750 mg once a day times 5 days, as necessary prophylactically and postoperatively.

When a patient is first found to have signs of infection of an implant, it can occur within 48 hours or it can be found many months later due to a staph coagulase which could be a light contaminant that remains dormant for many months. The obvious signs of infection include severe pain in the breast, redness, erythema, swelling and tenderness. Fever is also very common with temperatures over 101.5 degrees. An infected implant must be removed as soon as possible with a drainage tube placed under general anesthesia and irrigation after cultures, both aerobic and anaerobic are taken in order to determine the specific bacterial cause of this infection. Staphylococcus auris is the most common cause of an abscess which staph epidermis the most common cause of a contamination. After explantation, cultures and drainage placement, the patient will be seen postoperative day one and usually the patient will defervesce quickly and the pain will be immediately reduced. Swelling and redness will also be reduced greatly and effectively. Patients are maintained on antibiotics postoperatively and will be switched according to the specifics of the culture results.

The healing phase after an implant has been removed is dramatic. Initially, the patients are obviously very concerned with the aesthetic appearance of the breast. It is smaller, the skin becomes lax and the inferior periareolar incision can become inverted, meaning that the scar can retract and the nipple can be internally rotated. This can be extraordinarily deforming and patients who present to my office for reconstruction are often very worried and upset. The most important thing is the safety and health of each patient and making sure that things are done correctly. Number one, after receiving culture results, the patients are sent to our infectious disease specialists, usually at Cedars-Sinai Medical Center, who are brilliant. They are absolutely essential in helping us to determine the specifics of this infection, the etiologies, the reasons and how to treat it, as well as how to prophylax the patient for their reconstruction in the future. Once we have the proper culture results, the infectious disease doctors will make determinations as to what to put the patient on. Usually, it's going to be Vancomycin, which is given as 1 gram prior to the operation intravenously to the next surgery. When should we perform the next operation? It is usually not before three months and ranges anywhere between three and six months, depending upon the healing of the tissue. The more inflammation that was associated with the infection, usually the longer duration and time it takes for healing to occur. When reconstructing the breast, after we have had a thumbs-up clearance by an infectious disease specialist, say four or five months later, the surgery will require under general anesthesia, opening up the periareolar incision, releasing all the significant scar tissue, removing scar tissue as necessary and recreating a pocket. It is not Infrequent that we have to go with a slightly smaller implant in order to reduce the tension and increase scar contracture, which could cause hardening with a Baker IV capsular contracture. Therefore, the left implants may have to be replaced with a smaller implant as well. I do not place a drainage tube during the reimplantation phase. I believe that it may increase risk of infection by leaving a portal of entry along the inframammary fold with retrograde staph from the bulb reservoir back into the pocket.

Breast reconstruction after explantation is a very tricky operation. This requires a lot of skill. Board Certified Plastic Surgeons are the ones who should be performing these operations. They have the experience, years of knowledge and training to perform a proper surgery and to have the judgment as to determine what we can realistically do to recreate a normal appearance to the woman's body.

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Copyright® 2009

Stuart A. Linder, M.D., F.A.C.S. Beverly Hills Breast Revision Specialist
9675 Brighton Way Suite 420 - Beverly Hills, CA 90210
Phone: (310) 275-4513 - Fax: (310) 275-4813
Copyright® 2009