Intraoperative Predictors of Salvage in Infected Breast Implants: A Retrospective Study

Abstract Background Infectious complications associated with implant-based breast reconstruction (IBBR) can be devastating and may lead to reconstructive failure. Although there are known demographic risk factors for reconstructive failure, few studies have identified intraoperative findings that predict failure after attempted salvage. Objectives The objective of this study was to identify intraoperative findings in infected breasts that might be predictive of implant failure. Methods In total, 837 patients undergoing IBBR between January 2017 and July 2023 were included. Intraoperative records of patients who developed a major infection were reviewed. Reconstructive salvage denoted any intervention not resulting in explantation. Failure denoted explantation. Results Of 837 patients, 8% developed a major infection (n = 71). Within this group, 8% had successful treatment with intravenous antibiotics alone, 38% were salvaged after operative intervention, 28.2% failed without salvage attempt, and 25.4% underwent salvage attempt but ultimately failed. Overall, the rate of reconstructive failure was 53.5% and the rate of implant salvage was 46.5%. A total of 51% of patients returning to operating room were found to have unincorporated acellular dermal matrix (ADM). Seventy-eight percent of patients undergoing intervention had a positive culture, most commonly methicillin-susceptible Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, Serratia, Enterobacter, Pseudomonas or Proteus. Unincorporated ADM was significantly associated with reconstructive failure (odds ratio 5.4, P = .003). Serratia infection, hematoma, and gram-negative infection were associated with implant failure, but these findings did not achieve statistical significance. Conclusions Presence of unincorporated ADM was associated with eventual implant failure. Surgeons should be aware that this finding may portend poor outcomes for patients. These results may be helpful to intraoperative decision-making. Level of Evidence: 4 (Therapeutic)