Axillary Single-Tube Drainage with Intracavitary Irrigation for Prepectoral Implant Infection: A Multicenter Experience

When a woman undergoes a mastectomy to treat breast cancer, the journey often includes a second phase: reconstructing the lost breast. In recent years, surgeons have increasingly chosen a method that places the new breast implant just under the skin, above the chest muscle, rather than burying it beneath the muscle. This approach, known as prepectoral reconstruction, offers a more natural look and shape while sparing the patient the pain and stiffness associated with moving the chest muscle. However, like any surgery involving a foreign object placed inside the body, this procedure carries the risk of infection. When bacteria find their way to the implant, the situation can become dangerous. The body's immune system may attack the implant, causing fluid to build up, the skin to turn red and hot, and the wound to fail to heal. If the infection is not stopped, the only option has traditionally been to remove the implant entirely, leaving the patient with a flat chest and the need for further surgeries later.

For a long time, the standard response to such an infection was aggressive: open up the chest, scrub out the area, and often take the implant out. This approach, while sometimes necessary, frequently resulted in the loss of the reconstructed breast and left behind significant scarring. Researchers have been searching for a way to save the implant when possible, but finding a method that is both effective and simple enough to be used by many different hospitals has been difficult. A team of doctors from several hospitals in China recently tested a new strategy designed to clean out the infection without removing the implant, aiming to keep the breast intact and the patient's recovery on track.

The researchers focused on a specific technique that involves using a single tube to wash out the space where the implant sits. Instead of making a new, large cut in the skin, which could damage tissue that is already struggling to heal, the surgeons used the original small opening in the armpit where the implant was first placed. Through this existing doorway, they threaded a thin, flexible tube, about the thickness of a thick drinking straw, into the pocket between the implant and the chest wall. Once the tube was in place, they began a careful cleaning process. Three times a day, they would pour a mild antiseptic solution, similar to the kind used to clean skin before a procedure, into the space around the implant. They let it sit for a few minutes to kill bacteria, then sucked it back out. This was followed by a rinse with plain salt water to wash away any remaining debris. By having the patient lie down and then stand up, the fluid would naturally flow through the entire pocket, reaching every corner where infection might hide, effectively flushing the area clean from the inside out.

To see if this method worked, the team first looked back at their own records from a single hospital. They found five women who had developed infections after their prepectoral reconstruction. The causes of these infections varied: two women had developed infections after a lung infection spread through their blood, one had a reaction to radiation therapy that caused sterile inflammation, and two others had skin that failed to heal because of a combination of radiation and targeted cancer medication. In three of these five cases, the doctors were able to save the implant using this tube and wash method. The women received antibiotics tailored to the specific bacteria found in their fluid, and the tube remained in place until the fluid draining out was clear and the amount was very small. The two cases where the implant could not be saved were due to severe skin death that had already occurred before treatment began, a situation where the tissue was too damaged to hold the implant.

Encouraged by these initial results, the team shared their exact steps with three other hospitals to see if the method could be repeated by different surgeons. Over the course of several months, these collaborating hospitals treated seven more patients who developed similar infections. They followed the same strict rules: placing the tube within a day of noticing the infection, using the specific cleaning routine, and waiting for clear fluid before removing the tube. In this larger group, the method proved even more successful. Six out of the seven patients were able to keep their implants. The one failure occurred in a patient who, like the earlier cases, had extensive skin death that made saving the implant impossible. Across all the patients who successfully kept their implants, the infection was brought under control in about two weeks, and no new problems arose from the tube itself.

The study suggests that this approach works because it avoids causing further harm to the skin. By entering through the armpit, the surgeons did not have to cut through the fragile skin on the front of the chest, which is often the most vulnerable part after radiation therapy. The cleaning routine was also designed to be thorough yet gentle, using a solution that kills bacteria without irritating the tissue too much. The doctors also emphasized the importance of timing and teamwork. They noted that infections can sometimes come from distant parts of the body, like the lungs, rather than from the surgery itself, so treating the whole patient is just as important as treating the breast. They also highlighted that certain cancer medications, when given too soon after radiation, can make the skin so weak that it cannot heal, leading to infection. By adjusting the timing of these treatments and watching the patients closely, the risk can be managed.

This work does not claim to have solved every case of breast implant infection, nor does it suggest that the implant should be saved in every situation. When the skin is dead or the infection is too severe, removing the implant remains the necessary choice. However, for many patients, this simple, standardized method offers a reliable way to keep the implant in place. It provides a clear path for doctors in different hospitals to follow, turning a complex and often disastrous complication into a manageable problem. The success of the method in multiple hospitals indicates that it is not just a lucky finding in one place, but a practical solution that can be taught and used widely, giving more women the chance to recover their body image without losing their reconstruction.