Abstract
Background
Implant‐based breast reconstruction is associated with postoperative infectious and wound‐related complications that may compromise reconstructive outcomes, particularly in cohorts predominantly undergoing immediate reconstruction. Optimal management remains controversial, with no universally accepted salvage algorithm.
Methods
We conducted a retrospective cohort study of 198 patients (285 breasts) who underwent implant‐based reconstruction between 2013 and 2023, the majority of whom underwent immediate reconstruction. Implant‐threatening complications were defined as surgical site infection according to Centers for Disease Control and Prevention (CDC) criteria, full‐thickness skin necrosis, or deep wound dehiscence. A standardized institutional salvage protocol incorporating antibiotic therapy with or without surgical intervention was applied. Outcomes included implant salvage and final reconstruction status at the end of follow‐up, and logistic regression was used to identify predictors of salvage failure.
Results
Implant‐threatening complications occurred in 28.3% of patients, with salvage achieved in 51.8% of cases. All patients in the salvage group achieved final reconstruction, compared to 44.4% in the nonsalvage group (
p
p
= 0.04), implant extrusion (
p
= 0.008), and prior radiation therapy (
p
= 0.019) were independent predictors of salvage failure.
Conclusion
A protocol‐based salvage approach may facilitate implant preservation and improve final reconstruction rates. Early, case‐specific conservative management, tailored to local microbiologic patterns, may optimize outcomes.