(CR-013) Salvage of Infected Breast Prostheses using Negative Pressure Wound Therapy with Instillation and Dwell*

Peri-prosthetic infection is a common complication of implant-based breast reconstruction (IBBR), with a reported incidence between 1-35%.¹ Standard practice for moderate to severe infection is device removal and attempted delayed reinsertion weeks to months following completion of antibiotic treatment. Few studies have previously detailed the use of Negative Pressure Wound Therapy with Instillation and Dwell (NPWTi-d)* in this setting to foster successful implant salvage. The purpose of this study is to demonstrate its efficacy with a single institutional case series.


Methods: The authors retrospectively reviewed patients that underwent IBBR by one of three plastic surgeons at a single institution between November 2020 and December 2022. Patients with reconstruction complicated by peri-prosthetic infection and attempted prosthesis salvage with NPWTi-d* were included for further analysis.

Results: Fifteen patients (16 reconstructed breasts) had prosthesis salvage attempted with the NPWTi-d* device. Mean patient age was 52 years and BMI was 26.6 kg/m². Five patients had a history of chemotherapy and one patient had prior radiation. Patients presented with an infected tissue expander (n=10) or permanent implant (n=5) an average of 80 days from the initial reconstruction. Duration of NPWTi-d* was 59 hours on average, with three days of hospitalization. Successful salvage was ultimately achieved in 11 patients (73%) and 12 total infected breasts. Two of the eleven patients with successful salvage received a permanent implant at the time of NPWTi-d* removal. The remaining nine patients received a tissue expander and completed the second stage of reconstruction an average of 113 days from initial implant removal.

Discussion: Successful prosthesis salvage was achieved in most patients that developed moderate to severe peri-prosthetic infection with single application of a NPWTi-d* device. Compared to the traditional method of implant removal and delayed reinsertion, attempted salvage with NPWTi-d* may not only have a high success rate but benefit the patient through reduced recovery time and fewer reoperations.

Trademarked Items: * V.A.C VERAFLO CLENSE CHOICE device (KCI, Acelity, San Antonio, TX, US)

References: 1. Franchelli S, Pesce M, Baldelli I, Marchese A, Santi P, De Maria A. Analysis of clinical management of infected breast implants and of factors associated to successful breast pocket salvage in infections occurring after breast reconstruction. Int J Infect Dis. 2018 Jun;71:67-72.