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Innovative Management of Implant Exposure in ADM/Implant-Based Breast Reconstruction with Negative Pressure Wound Therapy

Aesthetic Plastic Surgery volume 41, pages 36–39 (2017)Cite this article

Abstract

Introduction

One-stage implant-based breast reconstruction has been recently improved by the introduction of biological [acellular dermal matrix (ADM)] and synthetic meshes. Advantages of ADMs in implant-based breast reconstruction derive from the expansion of the space available for the direct positioning of an implant, but their use could be associated with several complications. Although the majority of complications can be easily managed, mistakes in dealing with the first clinical signs of a potential adverse event can lead to implant loss.

Case Presentation

We report a case of ADM/implant exposure following NAC-sparing mastectomy and immediate implant-based reconstruction, successfully managed with an innovative staged treatment using negative pressure wound therapy, which allowed a rapid re-positioning of the prosthesis after complete clearance of bacteria from the implant pocket.

Discussion

The safest strategy to manage implant exposure and concomitant bacterial growth is reported to be implant removal and delayed re-positioning after several months, following prolonged targeted antibiotic therapy. Our case shows how a short-time implant re-positioning following implant removal for implant exposure could be successfully pursued thanks to the shrewd use of negative pressure wound therapy with great advantages in terms of patient satisfaction and post-operative quality of life, offering women experiencing this complication the option of not delaying reconstruction for months after resolution of the complication, potentially avoiding major surgical procedures such as autologous tissue reconstructions.

Level of Evidence V

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Author information

Affiliations

  1. Department of Surgery, Breast Unit, University Hospital “Federico II”, Naples, Italy

    Antonello Accurso, Giuseppe Accardo, Paola Reale & Carmela Salerno

  2. Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via S. Pansini 5, 80131, Naples, Italy

    Nicola Rocco

  3. Department of Clinical and Experimental Medicine Flaviano Magrassi, Clinical Medicine Hospital Unit, Ambulatory of Vulnology, Second University of Naples, Naples, Italy

    Edi Mattera

  4. Department of Plastic and Reconstructive Surgery, University of Naples “Federico II”, Naples, Italy

    Francesco D’Andrea

Authors
  1. Antonello Accurso
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  2. Nicola Rocco
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  3. Giuseppe Accardo
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  4. Paola Reale
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  5. Carmela Salerno
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  6. Edi Mattera
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  7. Francesco D’Andrea
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Corresponding author

Correspondence to Nicola Rocco.

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The authors declare that they have no conflict of interest to disclose.

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Accurso, A., Rocco, N., Accardo, G. et al. Innovative Management of Implant Exposure in ADM/Implant-Based Breast Reconstruction with Negative Pressure Wound Therapy. Aesth Plast Surg 41, 36–39 (2017). https://doi.org/10.1007/s00266-016-0739-1

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  • DOI: https://doi.org/10.1007/s00266-016-0739-1

Keywords

  • Breast reconstruction
  • A cellular dermal matrix
  • Negative pressure wound therapy
  • Implant exposure