Breast augmentation is the most frequent type of plastic surgery done in the UK and—after nose reshaping and liposuction—it is the third most common cosmetic procedure in the USA. However, infection complicates 2–2,5% of breast implantations, and is the leading cause of illness following such surgery. The comprehensive review in The Lancet Infectious Diseases of infection of breast implants is particularly timely in light of the recent call for tighter regulation of the private cosmetic surgery industry in the UK.

Professor Brigitte Pittet (Plastic and Reconstructive Surgery Unit, University of Geneva Hospitals, Geneva, Switzerland) and colleagues provide a fascinating journey through the history of breast implants and review the myriad risk factors for breast implant infections, before discussing clinical features such as toxic shock syndrome and late infection occurring months—or even years — after implantation. Diagnostic and management strategies are proposed for such problems.

In addition, they discuss the idea that capsular contraction—the leading long-term complication that follows breast implantation, involving the formation and contraction of a collagenous sheath around the implant, thus forming hard, spherical masses in the breasts— may be caused by subclinical infection, and could be prevented by antibiotics.

Brigitte Pittet comments: “Patients should be aware that, similar to other invasive procedures involving the implantation of foreign material, breast implants may lead to potential complications such as infection or capsular contracture. In good hands, however, infection remains infrequent.” 

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