This situation needs an urgent solution. The presence of both capsular contraction and very thin tissue will require a flap in order to offer the patient an immediate solution.

In this case a deep inferior epigastric perforator flap was offered to solve the problem with contralateral breast reduction at the same time (Figs. 32.7, 32.8, 32.9 and 32.10).

The final aesthetic outcome was acceptable, but there was a previous periprosthetic capsule remained at the parasternal part. So lipofilling was suggested as a possible improvement.

This is another case of a patient who originally underwent immediate reconstruction with an expander. The reason for using the expander was because of the presence of a very thin mastectomy skin flap; it can be considered an emergency reconstruction.

During the expansion there was a decubitus of the expander and the procedure was changed to autologous reconstruction with a deep inferior epigastric perforator flap (Fig. 32.11).

The final result at the time of nipple–areola reconstruction is shown in Fig. 32.12.

The salvage of the infected and or exposed breast prosthesis remains a challenging but viable option for a subset of patients.

Keys to success include culture-directed antibiotics, capsulectomy, device exchange, and adequate soft tissue coverage. Relative contraindications to breast device salvage include atypical pathogens on wound culture, such as Gram-negative rods, methicillin-resistant Staphylococcus aureus, and Candida parapsilosis.

Patients with a prior device infection and exposure and a history of either radiotherapy or S. aureus on wound culture should be closely monitored for signs of recurrent breast prosthesis infection/exposure and managed cautiously in the setting of elective breast surgery.