Background: Implant-based reconstruction (IBR) is the most common method of breast reconstruction, but complications lead to patient distress and delays in cancer treatment. Management of implant complications is varied with no defined guidelines. The inability to salvage IBR is associated with infection, but the impact of antibiotics remains controversial. We aimed to analyze factors affecting salvage rates of threatened IBR requiring operative intervention. The primary outcomes were the rates of unplanned re-operation for threatened IBR for wound closure, exchange, or explant. We hypothesized antibiotic administration would improve salvage rates. Methods: A retrospective review of patients undergoing mastectomy with IBR from 2012 to 2023 was performed. Threatened IBR was defined as implant exposure, infection, skin necrosis, hematoma, seroma, or wound dehiscence without implant exposure. Management options for patients with implant infection included implant removal and antibiotic treatment, antibiotic treatment alone, implant replacement, washout and implant replacement, or implant removal without a salvage attempt. Results: In total, 6901 patients underwent post-mastectomy IBR, and 184 (2.7%) patients had an unplanned re-operation. A total of 166/184 patients (90.2%) underwent explantation, and 18/184 (9.8%) patients had implant salvage. Between the explant and salvage groups, there were no differences in patient demographics, oncologic treatments, or operative characteristics. The explant group had a higher rate of infection (77.7% vs. 22.2%, p < 0.0001). There was no difference in culture positivity or antibiotic administration history. Conclusions: Implant salvage is feasible but limited by infection. Antibiotic administration does not improve salvage rates. Patient factors, oncologic treatment factors, or operative factors do not impact the ability to salvage.

Background: Implant-based reconstruction (IBR) is the most common method of breast reconstruction after mastectomy. Prior studies have demonstrated that complications rates vary with incision type. We evaluated whether incision type affected culture positivity in IBR complications. Methods: A retrospective cohort study was performed of all patients undergoing mastectomy for cancer or cancer prophylaxis with IBR from 2012 to 2023. Abstracted data included patient characteristics, oncologic treatment history, mastectomy and reconstruction characteristics, culture positivity, infectious organism, and antibiotic treatment history. Results: A total of 6901 patients underwent post-mastectomy implant-based reconstruction, 183 (2.7%) patients had unplanned operative intervention for IBR complications, and 80/183 (43.7%) had culture-positive IBR infections. Culture-negative and culture-positive groups were similar in patient characteristics and oncologic treatment history. There was no difference in mastectomy incision types. The most common organisms were methicillin-sensitive Staphylococcus aureus, Pseudomonas aeruginosa, and coagulase-negative Staphylococcus. More patients in the culture-positive group were treated with antibiotics (81.2% vs. 51.5%, p = 0.0005). Antibiotic therapy duration was longer in the culture-negative group (8.52 vs. 5.78 days, p = 0.039). Among different incision types, there was no significant difference in duration of antibiotic therapy. Conclusions: No association between mastectomy incision type and culture-positive infections was observed among IBR complications in this study. Antibiotics may sterilize cultures, but operative intervention is still often required for IBR infections.