Infections in Implant-based Breast Reconstruction: A Systematic Review of Risk Factors, Prevention, and Salvage Strategies

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Background Implant-based breast reconstruction (IBR) is the most commonly adopted technique following mastectomy due to its relative simplicity and shorter recovery time. However, infection remains one of its most frequent and challenging complications, potentially leading to delayed adjuvant therapy, increased healthcare costs, and implant loss. Objectives This systematic review provides an updated and structured appraisal of current evidence on infections in implant-based breast reconstruction, focusing on the following key outcomes: risk factors associated with postoperative infections; preventive strategies, including systemic and local prophylaxis; microbiological patterns and pathogen distribution; clinical outcomes across different reconstructive stages; and management and salvage approaches, including criteria for implant preservation versus explantation. Methods A systematic search was performed in PubMed, Scopus, Embase, and Google Scholar following PRISMA 2020 for studies published between January 2010 and May 2024. Studies were included if they reported original human data on infections after implant-based breast reconstruction. Results Twelve studies were analyzed for infection rates, microbiology, prophylaxis, and management. Infection rates ranged from 4.5% to 19.4%. Staphylococcus aureus and coagulase-negative staphylococci were most common. Main risk factors included obesity, diabetes, radiotherapy, smoking, and acellular dermal matrices. Preventive measures varied widely. Salvage was attempted in up to 80% of cases, with success rates of 42.9–90.9%. Biofilm and culture-negative infections were major challenges. Conclusions Infections in implant-based reconstruction remain multifactorial and clinically demanding, with heterogeneous prevention and management strategies and limited consensus. Standardized definitions, improved microbiology, and validated salvage pathways are needed to enhance outcomes.