Sterile Abscess: The Cure is a Bitter Pill to Swallow
Although they are fortunately quite rare (approximately 1-2% of cases), infection following breast augmentation is a disastrous complication. Most infections develop over the course of the first week to ten days after surgery, and because patients most always receive antibiotics at the time of surgery and usually for several days after surgery, the infection may develop more slowly. Often, even if there is draining pus, there may be no identifiable bacterial growth because it has been suppressed by the antibiotics. This is referred-to as a "sterile abscess".
Because the implants are "foreign" objects, surgeons must use every precaution to avoid contamination during breast augmentation. This includes minimal handling of the implants, meticulous preparation of the surgical field, and excellent surgical technique to minimize bleeding. In the rare cases where infection develops in spite of these measures, implant removal is almost always the ultimate outcome, as it is difficult to treat the infection with the now-contaminated implant still in place. Even if the implant can be salvaged by aggressive treatment with antibiotics, these patients seem to have a greater likelihood of developing capsular contracture.
It is undeniably disappointing to the patient and the surgeon alike when there is an infection requiring implant removal and drain placement, which is a very bitter pill to swallow when the goal of the surgery was attractively larger breasts with minimal scars. Although the actual cause of the infection can almost never be identified, the proper course of action requires that the infection is treated, since this can become life-threatening. Once the implants have been removed and the infection has cleared (usually after a waiting period of approximately six months), a second breast augmentation procedure can be done, hopefully with a better outcome.
Mycobacterial or fungal infections?
I sympathize with your situation. It seems as if all the proper actions have been taken. Despite the best of care, problems can arise and the most important thing is to manage them appropriately.
Have the cultures been sent for mycobacterial or fungal infections? These are extremely rare causes of breast implant infection but given your unusual history, it is a possibility.
While rare, your infection seems to have been treated appropriately
As you can see from the other answers, breast implant infection is a very rare complication. Fortunately, your doctor did the right thing and removed the implants because there is really no way to clear this without removing the prosthetic material. Once the drains are out and the tissues have settled down, new implants can be inserted. This is usually 6-12 weeks later.
It is usually not possible to determine the exact cause of the infection. All of this is very frustrating to the patient and to their physician.
Cultures can sometimes be negative when an infection is present
As the infectious disease doctor probably told you, sometimes cultures can be negative even when an infection is present especially when you are on antibiotics. This is a very unfortunate situation however infection is one of those rare risks of breast augmentation that is very difficult to treat when it does happen. Implant removal is sometimes what needs to be done and you have already seen and infectious disease doctor. Good luck!
Implant infections do happen
Although rare, breast implant infections do occur. It sounds as if it took a few weeks for your infection to develop, which is not uncommon. The fact that cultures have been negative to date is inconsequential since you were placed on antibiotics before cultures were obtained. The antibiotics may have knocked down enough bacteria to make your cultures show no growth. There is a type of bacteria that may take 6 weeks to grow in culture however, known as mycobacterium. Discussion with your infectious disease consultant will shed some light on this subject. Good luck.
My sympathies for your difficult and trying experience.
The persistent drainage may require removal of the capsules (lining) that formed around the implants.
Not having a culture to indicate the cause of the infection is frustrating, but can occur. Ask your doctors about the possibility of a fungal infection as a cause.
Wait at least 3 months after you are completely healed off antibiotics before replacing the implants.
Persistent drainage after breast implant removal might require removal of the capsule.
I hope that your problem is solved as I am writing this reply. If not, the capsule that formed around your prosthesis when it was in place may be the source of the infection. Another operation might be required. You situation is rare but sad. I hope things turn out well for you in a hurry.
Breast implant complications
Sometimes cultures can be negative even when an infection is present especially when you are on antibiotics. Infection is a very unfortunate situation in breast augmentation and is very difficult to treat when it does happen.
Implant removal is sometimes what needs to be done. Everyone has heard of a rare case like this. It happens more often in breast reconstruction than breast augmentation but simply because it is possible, it eventually is going to happen. Unfortunately you've had to deal with it. Your doctors have all done the correct thing in the management.
In cases of infected breast implant it is very important to remove the capsule.
The capsule can persist and harbor the bacteria and continue to seed the infection.
In your case if the capsule was not removed then you need another surgery to remove the capsule.
Breast Implants and infections
If you are still having significant drainage from the pockets, I would reassess the cultures to make sure something "funky" like a mycobacterium is not growing from them. I would also consider a secondary procedure to clean the pockets, perhaps even a capsulectomy to restore a healthy bed.