Periprosthetic mycobacterial infection. CT and mammographic findings

Surgical cure of clarithromycin resistant Mycobacterium chelonae breast implant infection: A case report and review of the literature

Clusters of patients who obtain cosmetic surgeries abroad have developed surgical site infections due to rapid growing non-tuberculous mycobacteria (NTM). These are usually treated with a combination of surgery and months of anti-mycobacterial therapy, but poor outcomes, including permanent scarring are common. We present a case of a 36-year-old female who developed a clarithromycin-resistant M. chelonae (CRMC) infection after undergoing breast augmentation in the Dominican Republic. She underwent debridement and explant of her silicone implants, but due to a series of complications including discordant antimicrobial susceptibility testing profiles, GI side effects, and then pregnancy, she was unable to receive typical multidrug anti-mycobacterial therapy after surgery. She received close clinical follow up and demonstrated full recovery without any evidence of recurrence of infection at 9 months of follow up. We searched the literature for cases of NTM surgical site infection after breast surgery. To our knowledge, this is the first case report of confirmed NTM breast implant infection being cured with surgery alone, and only the second report of clarithromycin resistant M. chelonae in a patient without disseminated infection or pre-exposure to macrolides. The increasing prevalence of drug resistant NTM infections is an emerging concern for clinicians treating patients with complications related to medical tourism.

Successful treatment of acute periprosthetic breast infection with curettage, pulse lavage, and immediate device exchange

Acute periprosthetic breast infection in aesthetic surgical patients is a rare event. These patients would be expected to be less tolerant of the standard option of removing the infected implant and waiting 6 months (or possibly more) for tissue conditions to become favourable prior to reinsertion. This report provides confirmatory evidence of a controversial method of management that involves removal of the infected implant, curettage of granulation tissue within the breast implant pocket, pulsed lavage, then switching to a "clean" setup (including gloves, gowns, drapes and instruments) and reinsertion of a new device with suction drainage. The technique allows for immediate replacement of the implant and if successful, obviates the need for any waiting period. Surgeons are encouraged to consider this management option in specific cases where tissue vascularity and patient health are satisfactory.

Subareolar Breast Abscesses: Characteristics and Results of Surgical Treatment

Our objective was to describe the characteristics of subareolar breast abscesses and to analyze the results of surgical treatment in relation to the prevention of recurrences. Almost 70% of patients smoked more than 10 cigarettes a day. The recurrence rate after excision of the lactiferous ducts was 28% and after management without excision of the lactiferous ducts was 79% (p < 0.001). Gram-positive bacteria were isolated more frequently in primary subareolar breast abscesses (not significant). Anaerobic microorganisms were more frequently cultured in recurring subareolar breast abscesses (p = 0.02). Definitive treatment of subareolar breast abscesses should consist of excision of the affected lactiferous ducts.

Retromammary fluid collection as a late complication of breast implants: magnetic resonance imaging findings

Imaging examinations, particularly magnetic resonance imaging (MRI), play an important role in the diagnosis of breast implant complications. Two cases of retroprosthetic serous-like fluid collection, an unusual late complication that has not been described previously in the literature, are presented. It is important for radiologists to know the MRI findings of this complication, which suggest the correct diagnosis, avoiding unnecessary additional procedures.