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B re a s t I m p l a n t Infections
Laraine L. Washer,
KEYWORDS  Breast augmentation  Breast implant  Infection
MD
a,b,

*, Karol Gutowski,

MD

c

Prosthetic breast implants are used for cosmetic breast enlargement, correction of asymmetries and congenital defects, as well as for breast reconstruction in women who undergo mastectomy for breast cancer or cancer risk reduction.Breast augmentation is the most common cosmetic surgical procedure performed in the United States with 296,203 procedures performed in 2010.1 Among women who undergo mastectomy, 10% to 20% have a reconstructive procedure and choose prosthetic implants, instead of autologous tissue reconstruction, 80% to 90% of the time.1,2 Breast implants may be placed between the pectoralis major muscle and thebreast gland (subglandular) or under the muscle (submuscular). In cases of breast reconstruction, the implants are typically placed entirely under the muscle through the mastectomy incision although either the subglandular or the submuscular position may be used for nonreconstructive procedures. For cosmetic purposes, the surgical approach is most commonly through an inframammary or periareolarincision and less commonly using a transaxillary, transareolar, or transumbilical incision. When performed for reconstruction after mastectomy, breast implants can be placed at the time of mastectomy (single-stage) or more commonly at a later time point (two-stage).3,4 When using a two-stage approach, a prosthetic tissue expander is placed first under the muscle. Then, after the incision has healed, theexpander is filled gradually through a subcutaneous port using weekly saline injections until the proper volume is achieved. At the next stage, the expander is removed and an implant is placed in the expanded pocket. Most commonly for reconstruction, the expander or implant sits in a pocket under the skin and pectoralis major muscle. However, in some types of reconstruction, the expander orimplant may be placed under a flap of autologous tissue.

The authors have nothing to disclose. a Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, 3119 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5378, USA b Department of Infection Control and Epidemiology, University of Michigan Health System, NI8B06 North IngallsBuilding, Ann Arbor, MI 48109, USA c Division of Plastic Surgery, University of Chicago Pritzker School of Medicine, Chicago, MC 6035, 5841 South Maryland, Chicago, IL 60637, USA * Corresponding author. Division of Infectious Diseases, University of Michigan Health System, 3119 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5378. E-mail address: laraine@med.umich.edu Infect Dis Clin NAm 26 (2012) 111–125 doi:10.1016/j.idc.2011.09.003 0891-5520/12/$ – see front matter Ó 2012 Elsevier Inc. All rights reserved. id.theclinics.com

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Washer & Gutowski

The two types of breast implants currently available in the United States are silicone gel and saline implants. Silicone implants contain silicone gel within a silicone polymer shell. Saline implants contain saline withinan outer silicone polymer shell. Saline implants are expandable and are filled at the time of insertion by the surgeon. Less common (and currently not available in the United States) are combined salinesilicone gel implants and polyurethane implants. Tissue expanders are similar to saline implants but are made of a thicker shell and have an injection port. Some types of tissue expanders can remainas permanent implants. For purposes of this discussion, unless otherwise specified, the term “implants” will refer to both breast implants and breast tissue expanders because the diagnosis and treatment of associated infections is similar. Acellular dermal matrix (ADM) products (discussed in detail below) may also be used in combination with tissue expander or breast implant surgeries performed...