Among the potential complications associated with the use of breast implants are the risks of periprosthetic infection and device extrusion. There is little published information on the effective management of these situations. Conservative recommendations include antibiotic therapy and/or removal of the implant until the wound has healed or the infection resolved. A multi-year retrospective review identified over 40 patients with periprosthetic infections or threatened or actual device exposure treated by the senior author. Patients were classified into six groups: isolated mild or severe infection, threatened exposure with or without infection, and actual exposure with or without clinical infection. To achieve successful primary prosthesis salvage, various strategies were utilized. Therapeutic options began with systemic antibiotics for patients with infection. Further aggressive interventions were performed when needed. All patients with mild, isolated superficial infections were successfully treated with antibiotics alone and retained their implants. Over 75% of patients with threatened or actual prosthesis exposure with or without infection were able to retain their implant after aggressive surgical intervention. The authors have developed an algorithm for the treatment of infection and threatened or actual implant exposure. No immediate salvage is attempted in cases of severe, non-responding infection with gross pus, marginal tissues or absence of options for healthy tissue coverage. Patients with infection are placed on oral or intravenous antibiotics; those that respond completely require no further treatment. If mild infection persists or threatened or actual exposure exists, operative intervention is required for implant removal, curettage, capsulectomy, debridement, site-change, placement of a new implant, and/or flap coverage. We have found that the infected or exposed breast prosthesis can usually be salvaged except in cases of overwhelming infection or deficient soft tissue coverage. Based upon this experience, patients can be offered the option of attempted implant salvage although removal remains a more predictable choice.