BACKGROUND: Infection following implant-based breast reconstruction (IBBR) represents a major complication, potentially leading to prosthesis removal. However, no clear protocol for its prevention and management exists. This study aimed to evaluate the efficacy of conservative treatment methods in preventing implant removal and analyze factors responsible for implant loss in the context of prepectoral IBBR. METHODS: A single-institution retrospective review chart of patients undergoing immediate prepectoral IBBR for breast cancer between October 2020 and January 2024 was performed. The inclusion criteria were the presence of at least one of the following postoperative complications: seromas, cellulitis, clinically suspected prosthesis infection, and confirmed periprosthetic infection. A comparative analysis between patients with successful conservative treatment (ultrasound-guided aspiration and antibiotic therapy) and patients undergoing implant removal was performed. RESULTS: A total of 219 immediate prepectoral IBBR cases were identified, 38 of which met inclusion criteria. Implant removal was required in 11 cases, whereas implant retention was achieved in 27 patients with conservative treatment. Implants were invariably removed when bacterial cultures were positive ( < 0.05). Conversely, when pathogens were not identified, the likelihood of implant removal decreased significantly ( < 0.05). Conservative treatment allowed implant salvage in all patients presenting with postoperative seroma alone, without other associated complications ( < 0.05). CONCLUSIONS: This study suggests that when bacterial cultures are positive, implant removal is unavoidable. Conversely, noninfected seromas correlated with implant salvage. Infections from and are reported for the first time.