Conservative Management of Breast Implant–Associated Infections: Identifying Risk Factors for Failure

Background Breast implant–associated infections remain a challenging complication, with limited high-quality evidence to guide management. Implant removal is often considered the standard approach, although conservative strategies aimed at implant salvage may be successful in selected patients. Methods We conducted a retrospective observational study of 42 patients diagnosed with breast implant–associated infection at a tertiary hospital between 2000 and 2024. All patients initially received antibiotic therapy without implant removal. Clinical, surgical, and microbiological variables were analyzed to identify predictors of treatment failure, defined as the need for implant removal. Logistic regression and Kaplan–Meier survival analyses were performed. Results Conservative management achieved infection control in 66.7% of patients, while 33.3% required implant removal. The most common symptoms were erythema (90.5%), pain (88.1%), and swelling (76.2%). Fistula was present in 33% and was strongly associated with treatment failure in univariable analysis (p=0.003), with a high odds ratio (7.5) in multivariable analysis. Elevated CRP and culture positivity correlated with poor outcomes. Staphylococcus aureus (36.8%) and Staphylococcus epidermidis (31.6%) were the most frequently isolated pathogens, although outcomes did not differ by microorganism. Kaplan–Meier analysis demonstrated a median failure-free survival of 191 months (almost 16 years), highlighting the potential long-term durability of conservative therapy in selected patients. Conclusions Conservative management may represent a valid therapeutic option for breast implant–associated infections in selected patients, particularly in the absence of fistula and persistent drainage. Prospective studies with larger cohorts and standardized protocols are needed to refine predictive models and establish evidence-based selection criteria for conservative therapy.