Infection After Breast Augmentation

The infection rate for breast augmentation is estimated to be 1.1% to 2.5%, based on multiple studies that have been conducted thus far. (However, there is a lack of consensus on how to actually define “infection”, therefore it is difficult to really say whether this figure is accurate.) There are a few factors that impact the risk of infection for breast surgery, whether it is for aesthetic or functional reasons.

• Diabetes
  
• Smoking
• BMI
• Prior breast surgery
  
• Steroid therapy
  

Those specifically related to the surgery are the following:

• Placement of peri-areolar incision (partially around the areola) – this is the most common cause of infection due to harmful bacteria located on the skin or breast duct/tissue.
  
• Contamination of the operating room.
• Contamination of the implant or saline (from the manufacturer).
• The patient has an existing infection somewhere else on their body.
• The occurrence of a hematoma or seroma.
  
• The placement of drains increases the risk of infection by 5 times.
• The duration of the procedure may also be a factor, but this requires further research.

TYPICAL SYMPTOMS OF INFECTION AFTER BREAST AUGMENTATION

Usual symptoms of bacterial infection include pain and tenderness, swelling, and erythema. Sometimes, there may also be a fever and purulent discharge (pus). Infection usually occurs within the first month (in two thirds of cases), the average being at the eleventh day mark. However, infection can also occur in the months to years after breast augmentation.

The diagnosis of infection is not always straightforward. It can exist just on the surface of the skin (simple cellulitis), be a superficial surgical site infection, or be a deep infection around the implant. A thorough medical examination must be performed, which typically includes a white blood cell count, swabs of discharge (pus) and blood culture (to check for sepsis).

An ultrasound of the breast can also be performed to check for fluid surrounding the implant, however even if there is no fluid present, there still may be an infection. That’s why it’s important to look out for other symptoms.

TREATMENT OF AN INFECTION AFTER BREAST AUGMENTATION

If either a skin or superficial site infection is suspected, oral antibiotics may be sufficient in treating it. In the case of a deep infection around the implant, antibiotics administered by IV tends to be more effective.

You may require surgery if the following occurs:

• There is a lack of response to antibiotics within 48 hours.
  
• The infection is not resolved within about a week
• There is a threatened exposure of the implant
• There is inflammation of the entire body (sepsis).

The Traditional Approach to Surgery

The implant is removed and any fluid present is submitted for testing (microbiology and pathology). A drain is inserted. There is no need to remove the implant (capsulectomy), unless there is a biofilm. Following surgery, antibiotics are administered by IV for two weeks, and then a new implant is placed after a specific infection-free period. Generally, this is in the range of about three to six months

Prevention of Infection

Our Plastic Surgeons take the greatest of care when performing your breast augmentation. There is good evidence that the following techniques contribute to good practices in preventing infection, to which our Plastic Surgeons adhere:

• Proper skin prep for surgery
• Thorough hand/forearm wash
• Clean surgical attire
• Proper ventilation in the operating room
• Minimize in/out traffic (especially when implant is exposed)
  

In addition, pre-op prophylactic antibiotics should also be administered as there is good evidence to support them. It is common practice to prescribe antibiotics post-op, although there is more evidence supporting pre-op antibiotics.