What is the prognosis for healing of breast implant-associated cellulitis?

From the Guidelines

Breast implant cellulitis typically requires prompt antibiotic treatment and close medical supervision for proper healing, with the recommended treatment including oral antibiotics such as cephalexin (500mg four times daily), dicloxacillin (500mg four times daily), or clindamycin (300mg four times daily) for mild cases, continuing for 5 days, as indicated by the Infectious Diseases Society of America guidelines 1. The choice of antibiotic should be active against streptococci, as they are the most common cause of cellulitis, and consideration should be given to coverage against methicillin-susceptible S. aureus (MSSA) in certain cases 1. For more severe infections, hospitalization and intravenous antibiotics like vancomycin or piperacillin-tazobactam may be necessary, especially if there are signs of systemic infection or if the patient is severely compromised 1. During healing, it is essential to apply warm compresses to the affected area for 15-20 minutes several times daily, take all prescribed antibiotics for the full duration even if symptoms improve, rest and elevate the chest when possible, and avoid manipulating the implant area. Elevation of the affected area is crucial as it promotes gravity drainage of edema and inflammatory substances, hastening improvement 1. Patients should also receive therapy for any predisposing conditions, such as tinea pedis, trauma, or venous eczema (“stasis dermatitis”) 1. Contact your surgeon immediately if you experience increased pain, redness, swelling, fever above 101°F, or drainage from the surgical site, as prompt treatment is crucial to prevent the infection from spreading to the implant capsule, which could lead to capsular contracture or necessitate implant removal in severe cases. Cellulitis occurs when bacteria enter through breaks in the skin, with Staphylococcus aureus and Streptococcus being common culprits, and the origin of the disrupted cutaneous barrier may be trauma, preexisting skin infections, or inflammatory dermatoses 1. Some key points to consider in the management of breast implant cellulitis include:

• The importance of prompt antibiotic treatment and close medical supervision
• The need for elevation of the affected area to promote gravity drainage
• The consideration of coverage against MSSA in certain cases
• The potential for severe or repeated episodes of cellulitis to lead to lymphedema
• The role of prophylactic antibiotics in reducing recurrences of cellulitis, although published results have been mixed 1. It is essential to follow the guidelines set by the Infectious Diseases Society of America for the diagnosis and management of skin and soft tissue infections, including cellulitis, to ensure the best possible outcomes for patients with breast implant cellulitis 1.

From the Research

Breast Implant Cellulitis Healing

• Breast implant cellulitis is a complication that can occur after breast implant surgery, with a reported incidence of 2.0 to 2.5 percent in cosmetic cases and up to 20 percent in reconstructive cases 2.
• The most common organism isolated from infected breast implants is Staphylococcus aureus, with 68 percent of infections being methicillin-resistant Staphylococcus aureus (MRSA) 2.
• Treatment of breast implant cellulitis typically involves antibiotic therapy, with the choice of antibiotic depending on the severity of the infection and the presence of any underlying medical conditions 3, 4.
• For mild infections, oral antibiotics such as penicillin, amoxicillin, and cephalexin may be sufficient, while more severe infections may require intravenous antibiotics such as gentamicin and vancomycin 3, 4.
• In some cases, surgical intervention may be necessary to salvage the implant, including débridement, curettage, pulse lavage, capsulectomy, device exchange, primary closure, and/or flap coverage 5.
• The presence of severe infection can adversely affect the salvage rate, with a statistically significant difference in salvage rates between patients with mild infection and those with severe infection 5.

Antibiotic Selection

• The choice of antibiotic for breast implant cellulitis should be based on the suspected or confirmed causative organism, as well as the severity of the infection 2, 3.
• Cefazolin is a commonly used antibiotic for perioperative prophylaxis, but its effectiveness against MRSA is limited 2.
• Gentamicin and vancomycin are effective against MRSA and may be used as alternative antibiotics for empiric treatment of breast implant infections 2, 3.
• The use of triple antibiotic pocket irrigants (TAPI) has been shown to be effective against some strains of Staphylococcus aureus, but its effectiveness against MRSA is limited 6.

Salvage Rates

• The salvage rate for breast implants with cellulitis or exposure can be high, with 76.9 percent of threatened implants being salvaged after aggressive intervention 5.
• The presence of severe infection can adversely affect the salvage rate, with a statistically significant difference in salvage rates between patients with mild infection and those with severe infection 5.
• Device removal and delayed reinsertion may be a more conservative and predictable option for patients with severe infection or deficient soft-tissue coverage 5.