{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T10:17:08Z","timestamp":1787825828228,"version":"build-2784847793"},"reference-count":23,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":238,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Breast Journal"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Implant\u2010based breast reconstruction is associated with postoperative infectious and wound\u2010related complications that may compromise reconstructive outcomes, particularly in cohorts predominantly undergoing immediate reconstruction. Optimal management remains controversial, with no universally accepted salvage algorithm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of 198 patients (285 breasts) who underwent implant\u2010based reconstruction between 2013 and 2023, the majority of whom underwent immediate reconstruction. Implant\u2010threatening complications were defined as surgical site infection according to Centers for Disease Control and Prevention (CDC) criteria, full\u2010thickness skin necrosis, or deep wound dehiscence. A standardized institutional salvage protocol incorporating antibiotic therapy with or without surgical intervention was applied. Outcomes included implant salvage and final reconstruction status at the end of follow\u2010up, and logistic regression was used to identify predictors of salvage failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Implant\u2010threatening complications occurred in 28.3% of patients, with salvage achieved in 51.8% of cases. All patients in the salvage group achieved final reconstruction, compared to 44.4% in the nonsalvage group (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.01). The most common complications were skin necrosis and wound dehiscence, followed by infection, and Gram\u2010negative organisms predominated among culture\u2010positive cases. Resistant organisms (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.04), implant extrusion (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.008), and prior radiation therapy (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.019) were independent predictors of salvage failure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A protocol\u2010based salvage approach may facilitate implant preservation and improve final reconstruction rates. Early, case\u2010specific conservative management, tailored to local microbiologic patterns, may optimize outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/tbj\/4668584","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T09:18:36Z","timestamp":1787822316000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["An Algorithm for Salvage of Implant\u2010Threatening Complications in Breast Reconstruction"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6398-8522","authenticated-orcid":false,"given":"Elizaveta","family":"Kouniavski","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5911-3861","authenticated-orcid":false,"given":"Shani","family":"Gilron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moran","family":"Lemberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pnina","family":"Ciobotaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Egozi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8402-0356","authenticated-orcid":false,"given":"Sharon L.","family":"Kracoff-Sella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"e_1_2_8_1_2","doi-asserted-by":"publisher","DOI":"10.3109\/2000656X.2014.970639"},{"key":"e_1_2_8_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000005040"},{"key":"e_1_2_8_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/ans.17118"},{"key":"e_1_2_8_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2021.05.070"},{"key":"e_1_2_8_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2011.09.003"},{"key":"e_1_2_8_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00266-020-01923-8"},{"key":"e_1_2_8_7_2","article-title":"National Healthcare Safety Network (NHSN) Patient Safety Component Manual","author":"Control CfD Prevention","year":"2025","journal-title":"Chapter 9: Surgical Site Infection (SSI) Event"},{"key":"e_1_2_8_8_2","doi-asserted-by":"crossref","DOI":"10.1097\/PRS.0000000000002839","article-title":"Late Surgical Site Infection in Immediate Implant-Based Breast Reconstruction","volume":"139","author":"Sinha I.","year":"2017","journal-title":"Plastic and Reconstructive Surgery"},{"key":"e_1_2_8_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000001336"},{"key":"e_1_2_8_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000001974"},{"key":"e_1_2_8_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000002325"},{"key":"e_1_2_8_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.14772"},{"key":"e_1_2_8_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2011.05.009"},{"key":"e_1_2_8_14_2","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.breast.2021.10.006","article-title":"Immediate Direct-to-Implant Breast Reconstruction With Acellular Dermal Matrix: Evaluation of Complications and Safety","volume":"60","author":"Kalstrup J.","year":"2021","journal-title":"The Breast"},{"key":"e_1_2_8_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.sap.0000252716.73356.68"},{"key":"e_1_2_8_16_2","volume-title":"Breast Implant Infections: Clinical Microbiology, Early Diagnosis, and Antibiotic Treatment","author":"Zhang H.L. Z. H.","year":"2015"},{"key":"e_1_2_8_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2018.06.007"},{"key":"e_1_2_8_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2019.07.020"},{"key":"e_1_2_8_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2021.09.060"},{"key":"e_1_2_8_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000003456"},{"key":"e_1_2_8_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000003896"},{"key":"e_1_2_8_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000002722"},{"key":"e_1_2_8_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2020.11.005"}],"container-title":["The Breast Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/tbj\/4668584","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/tbj\/4668584","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/tbj\/4668584","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T09:18:38Z","timestamp":1787822318000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/tbj\/4668584"}},"subtitle":[],"editor":[{"given":"Satabdi","family":"Datta Choudhury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":23,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/tbj\/4668584"],"URL":"https:\/\/doi.org\/10.1155\/tbj\/4668584","archive":["Portico"],"relation":{},"ISSN":["1075-122X","1524-4741"],"issn-type":[{"value":"1075-122X","type":"print"},{"value":"1524-4741","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2026-04-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-31","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"4668584"}}