What are the American Society of Plastic Surgeons (ASPS) guidelines for managing infected breast implants?

From the Guidelines

The American Society of Plastic Surgeons (ASPS) guideline for infected breast implants recommends prompt surgical intervention with complete removal of the implant and capsule (total capsulectomy), along with thorough debridement of infected tissue. This approach is supported by the most recent evidence, which highlights the importance of early intervention in reducing complications and improving outcomes 1. Antibiotic therapy should be initiated empirically with coverage for common pathogens including Staphylococcus aureus, coagulase-negative staphylococci, and gram-negative bacteria, such as vancomycin 15-20 mg/kg IV every 8-12 hours plus piperacillin-tazobactam 3.375g IV every 6 hours or cefepime 2g IV every 8 hours, with adjustment based on culture results 1.

Key Considerations

• Antibiotics should continue for 2-6 weeks depending on infection severity
• Reimplantation, if desired, should be delayed at least 6 months after infection resolution
• During surgery, multiple tissue samples should be collected for culture to identify the causative organism
• Biofilm formation on implants makes these infections particularly difficult to treat with antibiotics alone, necessitating device removal
• Patients should be monitored closely for signs of recurrent infection following treatment completion

Prevention of Future Infections

To reduce the risk of future infections, patients should consider the following:

• Avoiding extending postoperative antimicrobial use beyond 24 hours
• Allowing adequate incisional healing before initiating adjuvant bevacizumab use or radiation therapy
• Proceeding with early expansion of the tissue expander to decrease the size of the seroma pocket
• Keeping the surgical bulb at gravity at all times to keep the drained fluid from re-entering the surgical pocket
• Considering additional techniques, such as using chlorhexidine-impregnated dressing at the exit drain site and exchanging it weekly along with a daily antiseptic solution within the surgical bulb 1.

From the Research

ASPS Guideline for Infected Breast Implant

• The American Society of Plastic Surgeons (ASPS) guideline for infected breast implants is not explicitly stated in the provided studies, but the studies offer insights into the management and treatment of infected breast implants 2, 3, 4, 5, 6.
• Infection remains a common complication after breast reconstruction with expanders and implants, ranging from 2% to 29% 2.
• The use of broad-spectrum antibiotics is a common approach in the treatment of implant-associated infections, with the goal of salvaging the reconstruction 2, 5.

Treatment Strategies

• Various treatment strategies have been developed for periprosthetic infection and threatened or actual implant exposure, including antibiotic therapy, débridement, curettage, pulse lavage, capsulectomy, device exchange, primary closure, and/or flap coverage 3.
• The choice of antibiotic therapy depends on the severity of the infection and the presence of methicillin-resistant Staphylococcus aureus (MRSA) 4, 5.
• Oral fluoroquinolones may be used as a first-line treatment for mild infections, while intravenous imipenem or gentamicin and vancomycin may be initiated if the infection is severe or if the patient does not respond to oral antibiotics 5.

Outcomes

• The success rate of implant salvage varies depending on the severity of the infection and the treatment approach, with reported success rates ranging from 51.2% to 90% 3, 5, 6.
• Early intervention is critical to the success of implant salvage, and the majority of patients can be managed with antibiotic therapy alone 6.
• The presence of severe infection or deficient soft-tissue coverage may necessitate implant removal and delayed reinsertion 3.