Breast Implant Infections: How We Diagnose and Treat Them

Anytime an implant is in place, if you're operating anywhere in the area — even if you're not operating on the implant itself — that implant is at risk for infection. And it's more likely with thin tissue, like after a mastectomy.

Diagnosing an implant infection isn't always straightforward because they don't always present as an obvious infection.

• Blotchy redness is actually pretty common after surgery and usually isn't an indication of infection — it's just inflammation, especially with thin tissue.
• Dependent erythema — redness of the lower portion of the breast — is also part of normal healing.

So figuring out when it goes from normal to infection can be challenging. The way we do this is we watch. Normal things don't get worse. Infections get worse.

Most surgeons will start you on antibiotics if there's concern, because if it's something mild and superficial, we want to stop it before it spreads. But to be frank — if the infection is around the implant, antibiotics alone won't fix it. That's going to require surgery.

The antibiotics we typically use cover skin flora — bacteria that commonly cause infections in the surgical area:

• Keflex (cephalexin)
• Bactrim (trimethoprim-sulfamethoxazole)
• Clindamycin

And remember — you don't need IV antibiotics. People think since it's an implant, it's severe and needs IV. That's just not true. If you have a working gut, the appropriate antibiotic is the one that treats the bacteria, whether it's oral or IV. Oral antibiotics are much more accessible and work great.

If the breast is becoming more swollen, more red, and you're feeling ill — what do we do? There are really two paths:

1. Remove the implant — let everything cool off, then replace later
2. Implant salvage — attempt to save the implant with aggressive surgical washout

The most conservative option is removing the implant. If that's what your surgeon suggests, go with their recommendation. Don't try to bully them into saving it.

I tend to be more aggressive and attempt implant salvage when the patient isn't systemically sick. What do I mean by "sick"? High fever, malaise, looking bad, abnormal vitals. I look at the whole picture to determine if salvage is appropriate.

My steps in the operating room:

1. Open everything up and send cultures — I prefer MicroGen PCR because most patients have been on antibiotics, and standard cultures don't grow well in that setting
2. Remove the infected implant — it goes in the trash. You can't soak it in betadine and reuse it
3. Remove any mesh or prosthetic materials (dermal matrix, etc.)
4. Scrub the cavity with a scrub brush
5. Pulse lavage the cavity
6. Irrigate with a 50/50 mix of betadine and saline — let it sit for 10 minutes, then irrigate out
7. Place a new implant over a drain
8. Fill the cavity with Phase 1 hypochlorous solution — let it sit for 10 minutes before draining

I then continue the patient on broad-spectrum antibiotics that cover the most common bacteria I see causing implant infections in my practice.

You get one shot at implant salvage. If it doesn't work, the implant comes out. Once removed, we treat with antibiotics, allow the area to heal, and then place a new implant — usually three to four months after removal.

In general, you cannot treat an implant infection non-surgically. And it can be challenging to diagnose because many patients have symptoms that look like infection but are actually normal healing. The key is to follow the patient — do they get better, or do they get worse? If they get worse, it's time for the operating room.

If you're dealing with implant complications, feel free to reach out to discuss your options for breast revision or breast reconstruction.