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.