Background
The published techniques1 detailing methods of salvaging breast prosthetic devices include early empiric antibiotics, breast pocket washout, curettage and the use of negative pressure with or without instillation of antimicrobial solutions. There is no current consensus on techniques used to salvage infected breast prostheses. Our aim was to review the techniques used to treat infected breast prosthetic devices at a New Zealand tertiary referral centre over a two year period and document the risk factors associated with failed salvage attempts. This will better inform clinical practice, improve salvage rates and result in fewer operations with a shorter reconstructive journey for women.
Methods
Patients admitted to Middlemore Hospital in Auckland from January 2018 to December 2019 with a diagnosis of breast prosthesis related infection were included. Primary variables included demographics, smoking status, salvage success, peri-operative chemo/radiation and microbiology results.
Results
A total of 16 breast prosthetic device related infections were identified. The overall salvage rate was 43.8% (16.7% in 2018 v 60.0% in 2019). Smokers and ex-smokers had higher rates of salvage failure compared to non-smokers (83% v 50%). BMI and age were similar between salvage and failure groups respectively. Staphylococcus aureus and Staphylococcus epidermidis were the most commonly isolated pathogens on microbiological culture. Negative pressure with antimicrobial instillation therapy was only used in 2019 in and was associated with a 50% salvage rate.
Discussion
Middlemore Hospital has breast prosthetic device salvage rates comparable to published results. Attempted salvage led to a higher overall retention of breast prostheses in 2019 which may be attributed to new techniques (for example negative pressure therapy with the use of antimicrobial solution) and a more aggressive approach to salvage.
Conclusion
This study shows that attempting salvage after breast prosthesis infection is worthwhile, as it offers increasingly positive outcomes.