Healthcare-Associated Infections in Breast Implant Patients

Healthcare-associated surgical site infections in patients undergoing breast implant surgery have been documented at an increasing rate and are identified more often in patients undergoing construction versus augmentation. Infections have become the leading cause of postoperative morbidity in this population.

When working up a post-operative surgical site infection in breast implant patients, it is important to note the patient's medical or surgical condition. For example, patients who are undergoing mastectomy and radiation therapy for cancer will run a higher risk of infection than a healthy woman who is undergoing augmentation.

Operating room procedures and surgical technique are important to review as well. The origin of infection in women with breast implants can be complex, and may require the expertise of a clinical infection prevention specialist who can assist with an investigation and determine the nature of the infection and possible causes.

Of note in recent years is the emergence of an important group of opportunistic pathogens known as nontuberculous mycobacteria or NTM. They grow rapidly and are often thought to be a cause of infection in breast implant patients.

Phenelle Segal, RN, CIC, President of Infection Control Consulting Services, recently began consulting in Florida and has been hired by several office-based surgery practices as well as ambulatory surgery centers (ASCs) to assist with outbreaks or clusters of NTM. Breast implant infections related to mycobacterium fortuitum, abscessus and chelonae have been the predominant cases she has investigated. NTM is challenging and requires a specific workup for the potential causes. Plastic surgery practices, particularly those located in South Florida due to the heavy concentration of breast reconstruction and cosmetic services in the area, need to recognize the importance of vigilant infection prevention and control practices.

Phenelle has encountered patient infections with various bacterial offending organisms in other plastic surgery procedures in Florida besides breast implants. These include, but are not limited to, Brazilian Butt Lift infections and abdominoplasty infections. Staphylococcus aureus, MRSA and coagulase negative Staphylococcus surgical site infections have also been reviewed in the plastic surgery setting. On-site observation of the environment as well as specific clinical practices is imperative in order to mitigate the risk of infection.