How Would You Treat a Smoldering Infection That Continues 3 Mos After Breast Augmentation?

I had breast augmentation on July 26th. My right side healed perfectly, while the left filled with fluid, which burst the sutures a week later. For the past 3 months, it has drained. My ps has gone in once, removed it and cleaned out the pocket. She also has had to go back and reclose the area, trimming the bad skin. The skin is thin, and muscle under is spongy. We are removing that implant tomorrow. How long should we leave it out, and are there any other things to watch for?

Doctor Answers (14)

Removal of breast implant for infection

+2

This is not a common problem. I'm sorry that you developed an infection. It does happen.

For breast augmentation, I have only had to remove one implant in nine years of practice. I placed a new implant at three months without problem.

This is more common with tissue expanders in breast reconstruction because the expanders are textured and the overlying tissue can be tenuous from an aggressive mastectomy. In this set of patients, waiting 4-6 months is common.

It might not be a bad idea to wait 6 months in your case because you have been dealing with this for several months now. Certainly, listen to your plastic surgeon and go with her recommendations. She knows your case better than anyone.

Other things to consider are looking for fungal infection and atypical mycobacteria infections.  Again, this is uncommon but possible. These are the things plastic surgeons read about in books and hope that it never happens to any of their patients in their practice.

Good Luck to you for a speedy and complete recovery.


Nashville Plastic Surgeon
5.0 out of 5 stars 37 reviews

Extrusion of an Implant

+2

My experience in not vast in this department.  In twenty years of private practice, I have only removed 3 infected implants following breast augmentation surgery.  None of these patients had me as the original surgeon.  Each and every time, I have felt that the augmented breast had too large an implant given the stature of the patient.  If the skin becomes so thin that it appears translucent, the implant is PENDING extrusion.   It is better to remove that implant prior to the implant breaking through the skin.   

In each of these three patients, I have replaced the implant, no sooner than 6 months after I have removed the "infected/extruded" implant.   Each and every time, I have replace BOTH implants in both breasts, making the implant size 25-50 cc smaller.   All the women are very happy and they all love their "new breast size."   

 

Jonathan Berman, MD
Palm Beach Plastic Surgeon
5.0 out of 5 stars 6 reviews

You are worried about infection after augmentation...

+1

It is very unfortunate that you have to go through this but it is one of the known complications and could happen to anybody. I have not had to remove an implant for infection but I have dealt with many patients coming to my office after having breast augmentation in south America who have had infections. My treatment is removal of the implant, washing out the pocket, checking cultures, and antibiotics. I let the infection resolve and pocket close for 6 to 9 months.

Jacob Freiman, MD, FACS
Miami Beach Plastic Surgeon
5.0 out of 5 stars 96 reviews

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When to Replace a Breast Implant After Removal

+1

I'm sorry to hear about the troubles you're having with your breast implants.  I agree with previous responses that at this point it seems appropriate to remove the implant.  I generally wait three to six months before replacing an implant after removal because of infection.  This gives adequate time to resolve the infection and tissues to heal.  During this time, try to be patient and follow the advice of your plastic surgeon.  The better healed and more stable your tissues are at the time implant remplacement, the better your results will be.

Jaime Perez, M.D.

Breast Implant Specialist in Tampa, FL

Plastic Surgery Center of Tampa, FL

Jaime Perez, MD
Tampa Plastic Surgeon
5.0 out of 5 stars 28 reviews

Removal is the answer for now in my opinion

+1

yes removal is the answer for now in my opinion.... wait at least 3 months.     If the surgeon felt that the wound closure was tight, then it may be wise to switch out both implants for smaller ones, maintain symmetry, and to reduce the changes for extrusion... good luck  

Alan Weiss, MD
Baltimore Plastic Surgeon
5.0 out of 5 stars 1 review

Wait at least 6 months from the time infection has resolved

+1

You need to take out the implant first and then wait until all signs of infection are gone and all your tissues have healed, and then wait at least 6 more months before attampting another surgery if your still up for it.  Complicated and very rare issue.  

Andre Aboolian, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 44 reviews

Waiting for re-augmentation after implant infection

+1

Hello,

Sorry to hear about your experience.  The answer about timing depends on each patient but it is usually 30-90 days for most surgeons.  The bigger question is why did you get a seroma and infection and wound dehiscence (wound healing problem) in the first place.  Answering this will help prevent the event from recurring.  It will also be good to consider placing the implant in a fresh pocket as opposed to just entering and modifying the old pocket.  Full removal of the entire capsule may also be a wise move along with a drain.

All the best,

Dr Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 96 reviews

Breast Augmentation - How Would You Treat a Smoldering Infection That Continues 3 Mos After Breast Augmentation?

+1

I am obviously very sorry that you're having this problem and, just as obviously, there is a limited amount of information that I can give via this forum.  Being able to see and examine the patient, and know what she looked like before, the surgery that was done, etc., is paramount in working out a plan.  That being said, there are some general principles, and it sounds like you're heading in the right direction.  First of all, if there is an ongoing infection, the implant has to come out.  You can try to save it with one or two small procedures but this is generally delaying the inevitable (nothing is 100%, of course).  The question then is whether you want to remove the other implant.  If the overall plan is to reinsert an implant, then you would generally need to wait 3-6 months, after which you can have it reinserted.  You may want to address the issue of adding acellular dermal matrix if your skin is very thin, which sometimes happens with prolonged healing.  That, too, raises other issues, but this will be the time for you to consider everything.  And that includes getting additional opinions, if you feel that would be useful.  If there is enough of your own tissue remaining and you're not going too big for the size of the pocket, you should be able to reinsert the implant.  Again, I'm sorry but hopefully things will work out despite this "bump along the way" and you'll get the result you were aiming for.

I hope that this helps, and good luck,

Dr. E

Alan M. Engler, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 151 reviews

Infection Around Breast Implant

+1
It is very difficult to clear an infection as long as a foreign body such as a breast implant is present. After a trial of antibiotics, as your surgeon has provided,removal of your infected implant is indicated. Cultures are important to identify the organism for effective selection of antibiotic. Removal of the capsule would help eliminate any "biofilm" residual from bacteria. Occasionally the implant that appears uninvolved can be seeded with bacteria from the infected side so that both sides are a risk. These choices are made at the clinical judgement of your surgeon.

Mary Lee Peters, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 93 reviews

How Would You Treat a Smoldering Infection That Continues 3 Mos After Breast Aug?Answer:

+1

I agree that the implant really has to come out and you are doing the right thing…And it is very rare. I have had maybe 3 in 18 years. I would suggest a minimum of 3 months (longer if possible) and I think the suggestion of smaller implants is good too if possible. And in patients with very thin skin, I have had success with Strattice as a reinforcement as well but it is expensive.

John J. Corey, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 19 reviews

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