What is the treatment for breast implant-associated cellulitis?

From the Guidelines

Breast implant cellulitis requires prompt antibiotic treatment, typically with coverage for common skin pathogens like Staphylococcus aureus and Streptococcus species, as well as consideration of methicillin-resistant staphylococci (MRSA) and gram-negative pathogens, given the high infection rate of 13% in patients with breast tissue expanders 1. The first-line treatment usually involves oral antibiotics, but the choice of antibiotic should be guided by the severity of the infection and the patient's risk factors.

• For typical cases of cellulitis without systemic signs of infection, an antimicrobial agent active against streptococci is recommended 1.
• For more severe cases or those with systemic signs of infection, coverage against MRSA and gram-negative pathogens should be considered 1. Some possible oral antibiotic options include:
• Dicloxacillin 500 mg four times daily
• Cephalexin 500 mg four times daily
• Clindamycin 300-450 mg three times daily For patients with more severe infections or those unresponsive to oral therapy, intravenous antibiotics may be necessary, such as vancomycin 1. Patients should also apply warm compresses to the affected area, take anti-inflammatory medications like ibuprofen for pain and swelling, and maintain good hygiene. It's crucial to seek immediate medical attention as untreated cellulitis can progress to a breast implant infection requiring implant removal. During treatment, patients should watch for worsening symptoms, including increased pain, redness, swelling, fever, or drainage, which may indicate treatment failure or abscess formation 1. The recommended duration of antimicrobial therapy is typically 5-14 days, but treatment should be extended if the infection has not improved within this time period 1.

From the Research

Breast Implant Cellulitis Treatment

• The treatment of breast implant cellulitis typically involves the use of antibiotics, with the goal of salvaging the implant and preventing further complications 2, 3.
• A study published in 2013 found that initial cellulitis amenable to oral antibiotics should be treated with oral fluoroquinolones as a first-line treatment, with intravenous imipenem or gentamicin and vancomycin as alternative options if the initial treatment fails 2.
• Another study published in 2004 found that salvage attempts for periprosthetic infection and prosthesis exposure may be successful, except in cases of overwhelming infection or deficient soft-tissue coverage, and that device removal and delayed reinsertion may be a more conservative and predictable option 3.
• Broad-spectrum antibiotics, such as daptomycin with piperacillin-tazobactam, may be effective in treating periprosthetic infection, but may also be associated with adverse events such as diarrhea, rash, and vaginal candidiasis 4.
• Empiric outpatient therapy with trimethoprim-sulfamethoxazole, cephalexin, or clindamycin may be effective in treating cellulitis, with trimethoprim-sulfamethoxazole having a higher treatment success rate than cephalexin 5.
• Doxycycline-coated silicone breast implants may reduce acute surgical-site infection and inflammation, by inhibiting biofilm formation and bacterial adherence 6.

Antibiotic Selection

• The selection of antibiotics for the treatment of breast implant cellulitis should be based on the suspected or confirmed causative organism, as well as the patient's medical history and allergy profile 2, 3.
• Broad-spectrum antibiotics may be necessary in cases where the causative organism is unknown or suspected to be resistant to narrower-spectrum antibiotics 4.
• The use of antibiotics with activity against community-associated MRSA, such as trimethoprim-sulfamethoxazole and clindamycin, may be preferred in areas with a high prevalence of MRSA infections 5.

Treatment Outcomes

• The outcome of treatment for breast implant cellulitis may depend on various factors, including the severity of the infection, the presence of underlying medical conditions, and the promptness and effectiveness of treatment 2, 3.
• Salvage of the implant may be possible in some cases, but device removal and delayed reinsertion may be necessary in cases of severe infection or deficient soft-tissue coverage 3.
• The use of broad-spectrum antibiotics may be associated with adverse events, and the treatment should be carefully monitored to minimize the risk of complications 4.