Implant infection after prepectoral breast reconstruction treated with negative pressure wound therapy and photobiomodulation: a case report.

Abstract

Prepectoral breast reconstruction is a relatively new surgical technique that allows placement of the implant directly over the pectoralis major. It has benefits in terms of patient wellbeing, operative time, postoperative pain and recovery. However, in cases of infection, implant removal is often required and the patient is left with a flat chest. To the authors' knowledge, this is the first case of breast implant infection after breast reconstruction, successfully treated with a combination of both negative pressure wound therapy (NPWT) and photobiomodulation (PBM). A 32-year-old female patient with a BRCA2 mutation had undergone bilateral risk-reducing, nipple-sparing mastectomy for in situ ductal breast carcinoma followed by a prepectoral reconstruction. On the left side, the patient presented with dehiscence of 2.5cm with implant exposure 90 days after surgery. After an initial conservative approach, the patient's condition worsened, and she developed a larger dehiscence and a red breast. She was treated with implant removal. PBM of the cavity and the application of VeraFlo Therapy (3M, US) with a polyurethane-foam filling in the residual cavity were adopted. Pseudomonas aeruginosa was isolated and appropriate antibiotic therapy was started. Every 48-72 hours, she returned to the operating room for a washout, PBM, microbiological swabs, foam exchange and continuing NPWT. After 21 days of this approach and two consecutive negative swabs, the patient underwent breast reconstruction with a subpectoral expander. After six months, a definitive implant of the same size as the contralateral one was positioned. The cosmetic result was good and patient satisfaction was high. The combination of NPWT and PBM may represent a good solution in case of breast implant infection after prepectoral reconstruction with benefits in terms of surgical outcome, patient satisfaction and postoperative quality of life.