Written by: Stuart A. Linder, M.D., F.A.C.S.
The symptoms of breast implant infection follow the four cardinal signs that are seen with infection throughout the body. These include calor, rubor, tumor and fever. In general, an infected breast implant acutely presents with severe pain, swelling, and redness. Patients also often present with a fever and possible cellulitis or redness to the skin. Classic signs of infection early on are associated with the unilateral swollen, painful, red hot breast. At times, purulence, either as a pus-like or a pure staph sticky fluid may be exuding through the incision site, periareolar or inframammary, with redness surrounding the incision site. Mild palpation of the breast often leads to severe pain and tenderness. This is a tell-tell sign of an acute breast implant infection.
The most common infection of breast implants includes staphylococcus epidermis from the skin followed by an abscess by staphylococcus aureus. Pseudomonas aeruginosa and e-coli gram negative rods may also be associated with infected implants. Normally, infections are seen within the first seven days. When a patient presents with obvious signs of an infected implant, the treatment is usually explantation of the implant, culture and sensitivities, aerobic, anaerobic and fungal, irrigation of the pocket, implant is removed completely and a drainage tube is placed for at least seven days. I do not reimplant an implant for a minimum of 8 to 12 weeks. Our patients are seen by infectious disease specialists in order to rule out MRSA and to evaluate for future reimplantation surgery. Often patients are placed on Vancomycin 30 minutes prior to reimplantation and are given special preps, both nasal and body washes, by the infectious disease specialist, 3 to 5 days prior to the secondary reimplantation surgery.
Infections can occur either acutely and may also occur in a chronic period. Infections can occur years later from bacteremia from even a sinus infection or bacteremia from a dental procedure in which bacteria introduced into the vascular gums or mucosa of the oral cavity which spreads to the breast implant pocket, leading to staph epidermis or staph aureus abscess. New theories for infectious disease specialists are that there may be staphylococcus aureus or epidermis already colonized within the pocket and even a blunt trauma to the bio microfilm can cause disruption of this small pocket of staph which could then lead from a dormant to now active staphylococcus infection. This may be one of the reasons for disruption of the biofilm with staphylococcus of long-term infected implants.
Once a patient is shown to have an infected implant, explantation with drainage and cultures should be done immediately. Trying to maintain an implant in an infected pocket is in no way a service to any woman’s body. The only way the breast will heal is to remove the implant, clean the pocket, drain it and allow for complete healing prior to reimplantation in a sterile environment.
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Stuart A. Linder, M.D., F.A.C.S. is a Beverly Hills plastic and reconstructive surgeon specializing in breast augmentation, liposuction, tummy tuck, and more.
Dr. Linder is certified by the American Society of Plastic and Reconstructive Surgeons and is a diplomate of the American Board of Plastic Surgery.