Implant salvage in post-mastectomy reconstruction complicated with infection: molecular diagnosis and negative-pressure wound therapy combined with expander

Abstract

Breast implant infections are a critical concern in post-reconstructive surgery, often requiring implant removal and delayed reconstruction. To address this challenge, we implemented a “fast-track protocol” integrating rapid molecular diagnostics with advanced surgical techniques to salvage the implant and reduce patient morbidity. A case series of 11 patients treated with this brand-new protocol at our Institution from January 2023 to October 2024 was collected. Each patient underwent preoperative screening and, upon signs of infection, received immediate analysis of periprosthetic fluid using the FilmArray^TM PCR system. This approach enabled the rapid identification of pathogens and the initiation of targeted antibiotic therapy within 24 h after implant removal. The surgical intervention included debridement, Negative-Pressure Wound Therapy with saline instillation, and the use of a tissue expander to maintain pocket integrity and width. The integration of the FilmArray^TM PCR system and Negative-Pressure Wound Therapy with instillation resulted in successful salvage of breast reconstructions in 11 out of 11 cases within a medium ten-day timeframe. This series underscores the potential of combining rapid molecular diagnostics with tailored surgical strategies to enhance outcomes in breast implant infections.

Keywords

Breast implant infection / molecular diagnosis / fast-track protocol / FilmArray^TM PCR / negative-pressure therapy / targeted antibiotic therapy / breast reconstruction / implant salvage

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