Complications Requiring Breast Revision Surgery
“Breast Implant Infection”
Breast implant infection is always an unforeseen complication, but is very rare and can usually be avoided with proper surgical care.
Breast implant infections tend to arise from bacteria that enter the patient either during or after breast implant surgery. Breast implants are like any other prosthetic device insomuch that they have a higher risk of infection than non-implant surgery. Artificial heart valves, knee or hip joints and other non-human medical devices historically have a higher risk of infection since the devices themselves are not living human tissue. Once bacteria come in contact with an implant, the body’s own defenses cannot easily fight off an infection. Even with the use of antibiotics, infections cannot always be prevented, or if already present, always cured.
Infections can arise during one of time periods. The first time period is pre-operatively (before surgery) where bacteria may already be lurking in the body ready to infect the patient once an implant is placed. This could be an existing infection such as a bladder infection or lung infection that is minor but unnoticed by the patient. It is important that all prospective breast implant patients undergo pre-operative blood and urine testing to make sure the body is free of infection before the operation. If an infection is found, it must be treated before proceeding with the breast implant surgery. As a precautionary measure, it is also a good idea to treat any breast implant patient the night before the operation with prophylactic antibiotics.
The second, and most important time period, is that time during the actual operation itself. It is very important that a patient undergo surgery in a sterile environment such as a surgery center or hospital. Frequently, breast implant surgery is performed in the back room of a doctor’s office, which sometimes can lead to less than ideal sterile conditions. All patients should be receiving pre-operative IV antibiotics before going into the operating room. Preparation of the skin around the breasts in the surgical area is also very important, just as the surgeon’s sterile technique in conducting the operation. The operating room should be staffed with a scrub tech and circulating nurse in addition to the anesthesia personnel. Extreme care must be used when handling the implant to avoid contamination during its preparation and insertion. Wound closure and bandaging must be done in a sterile manner to also prevent contamination of the operative site.
The third time period is the immediate post-operative recovery stage, which is usually the first 10 to 14 days after an operation. If an infection is going to show itself, this is usually when it is seen. Infections can have many signs and symptoms such as fever, chills, redness, swelling and infectious discharge either directly at the wound site or in the surrounding area. If this occurs, the patient needs to contact their surgeon immediately. Do not wait. If bacterial contamination occurred before or at the time of operation, an infection will usually show itself in about 5 to 7 days. If bacterial contamination occurs immediately after the operation, from early non-sterile contact with the wound or for other reasons, the infection may not become apparent until a few days later. Submersing newly operated breasts underwater is something that must be avoided for six weeks after surgery. Bacteria can enter the breast implant pocket either through the incisions or up through the milk ducts in the breast tissue and infect the implant. It takes about six weeks for the implant to become completed sealed off inside the breast pocket and the likelihood of infection through the incisions and/or the milk ducts becomes rare.
The fourth time period begins at 90 days after surgery and lasts the rest of the patient’s life. Anytime a patient is exposed to bacteria in the bloodstream, one needs to be concerned about infection. This can occur from a serious medical illness such as pneumonia or intestinal infections. It can also occur whenever the patient undergoes surgery or dental work. We have seen implant infections in patients who had recently undergone minimal foot surgery or developed sinus infections. The patient’s medical provider should be made aware that a patient has breast implants and he or she should treat that patient with prophylactic antibiotics, just as they would treat a patient with a heart valve or joint replacement.
Treatment for a breast implant infection is removal of the infected breast implant, placement of a drain in the breast pocket and antibiotics for at least 10 days afterwards. Some surgeons will try to salvage the implant by leaving it in and giving antibiotics, but this is not the correct treatment. Invariably the implant will remain infected and have to be removed at a later date. Reinsertion of a new implant can be performed safely about four months later. The original infected implant cannot be reused. If you suspect you have a breast implant infection it is imperative that you contact a breast revision surgeon immediately.
Please contact our office if you are from outside the Southern California area for a preliminary telephone conversation with Dr. Moser personally to ascertain if an in-person consultation would be helpful to you.