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Mayer HF, Palacios Huatuco RM, Ramírez MF. Reverse abdominoplasty as a salvage procedure for infected bilateral implant-based breast reconstruction. Int J Surg Case Rep 2024; 117:109490. [PMID: 38484459 PMCID: PMC10955662 DOI: 10.1016/j.ijscr.2024.109490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/27/2024] [Accepted: 03/06/2024] [Indexed: 03/24/2024] Open
Abstract
INTRODUCTION Infection is one of the most feared complications of implant-based breast reconstruction and is difficult to manage in irradiated patients. We present the first case of bilateral breast reconstruction with infected expanders salvaged by performing a reverse abdominoplasty. PRESENTATION OF CASE A 64-year-old woman with a history of locally advanced bilateral breast cancer underwent modified bilateral radical mastectomy and postmastectomy radiotherapy. We performed two-stage breast reconstruction with implants. However, the patient developed a mild infection of the expanders, which was treated with targeted oral antibiotic therapy. The response to treatment was favorable, allowing us to salvage the reconstruction with a reverse abdominoplasty. DISCUSSION Traditionally, the management of infected breast prostheses has consisted of removal of the infected implant, a complication that forces a delay in the reconstructive process. Successful reports of salvage of infected prostheses have been described in the literature. On the other hand, we were able to salvage the reconstruction by performing a reverse abdominoplasty, which allowed us to resect the irradiated tissue and provide adequate non-irradiated soft tissue coverage for the replaced implants. CONCLUSION Reverse abdominoplasty offers an acceptable aesthetic result with much less donor site morbidity and represents a valid alternative to other complex reconstruction techniques.
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Affiliation(s)
- Horacio F Mayer
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires Medical School, Hospital Italiano de Buenos Aires University Institute (IUHIBA), 4190 Peron St., 1st. floor (C1991ABB), Buenos Aires, Argentina
| | - René M Palacios Huatuco
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires Medical School, Hospital Italiano de Buenos Aires University Institute (IUHIBA), 4190 Peron St., 1st. floor (C1991ABB), Buenos Aires, Argentina.
| | - Mariano F Ramírez
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires Medical School, Hospital Italiano de Buenos Aires University Institute (IUHIBA), 4190 Peron St., 1st. floor (C1991ABB), Buenos Aires, Argentina
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Talwar AA, Lanni MA, Ryan IA, Kodali P, Bernstein E, McAuliffe PB, Broach RB, Serletti JM, Butler PD, Fosnot J. Prepectoral versus Submuscular Implant-Based Breast Reconstruction: A Matched-Pair Comparison of Outcomes. Plast Reconstr Surg 2024; 153:281e-290e. [PMID: 37159266 DOI: 10.1097/prs.0000000000010618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Implant-based breast reconstruction is the most common reconstructive approach after mastectomy. Prepectoral implants offer advantages over submuscular implants, such as less animation deformity, pain, weakness, and postradiation capsular contracture. However, clinical outcomes after prepectoral reconstruction are debated. The authors performed a matched-cohort analysis of outcomes after prepectoral and submuscular reconstruction at a large academic medical center. METHODS Patients treated with implant-based breast reconstruction after mastectomy from January of 2018 through October of 2021 were retrospectively reviewed. Patients were propensity score exact matched to control demographic, preoperative, intraoperative, and postoperative differences. Outcomes assessed included surgical-site occurrences, capsular contracture, and explantation of either expander or implant. Subanalysis was done on infections and secondary reconstructions. RESULTS A total of 634 breasts were included (prepectoral, 197; submuscular, 437). A total of 292 breasts were matched (146 prepectoral:146 submuscular) and analyzed for clinical outcomes. Prepectoral reconstructions were associated with greater rates of SSI (prepectoral, 15.8%; submuscular, 3.4%; P < 0.001), seroma (prepectoral, 26.0%; submuscular, 10.3%; P < 0.001), and explantation (prepectoral, 23.3%; submuscular, 4.8%; P < 0.001). Subanalysis of infections revealed that prepectoral implants have shorter time to infection, deeper infections, and more Gram-negative infections, and are more often treated surgically (all P < 0.05). There have been no failures of secondary reconstructions after explantation in the entire population at a mean follow-up of 20.1 months. CONCLUSIONS Prepectoral implant-based breast reconstruction is associated with higher rates of infection, seroma, and explantation compared with submuscular reconstructions. Infections of prepectoral implants may need different antibiotic management to avoid explantation. Secondary reconstruction after explantation can result in long-term success. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Ankoor A Talwar
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania
| | - Michael A Lanni
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania
| | - Isabel A Ryan
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania
| | - Pranav Kodali
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania
| | - Elizabeth Bernstein
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania
| | - Phoebe B McAuliffe
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania
| | - Robyn B Broach
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania
| | - Joseph M Serletti
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania
| | - Paris D Butler
- Division of Plastic Surgery, Department of Surgery, Yale Medicine
| | - Joshua Fosnot
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania
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Su X, Hu J, Jiang F, Wu Y, He J, Jia X, Zhan S. Evaluation of pathogen distribution and antimicrobial resistance in breast plastic surgery infection. J Cosmet Dermatol 2024; 23:179-185. [PMID: 37409445 DOI: 10.1111/jocd.15919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 01/18/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND The demand for mammaplasty has increased in recent years, and infection remains one of the common and serious post-operative complications. In this study, we analyzed the pathogen distribution and antibiotic susceptibility of breast plastic surgery infections, and compared the differences in pathogenic species between surgical procedures. METHODS The number of each species was counted in the microbial samples of breast plastic surgery infections in Plastic Surgery Hospital of Chinese Academy of Medical Sciences from January 2011 to December 2021. The in vitro antibiotic sensitivity testing data were analyzed using WHONET 5.6 software. The surgical techniques, the period of infection, and other details were gathered in accordance with the clinical data. RESULTS There were a total of 42 cases included, and 43 different types of pathogenic bacteria, mostly gram-positive bacteria, were found. CoNS (13/43) and Staphylococcus aureus (22/43) made up the majority. The most prevalent of the five Gram-negative bacteria was Pseudomonas aeruginosa. Results of drug sensitivity tests indicate that S. aureus is highly sensitive to vancomycin, cotrimoxazole, and linezolid, whereas CoNS is highly sensitive to vancomycin, linezolid, and chloramphenicol. Both of these bacteria show high resistance to erythromycin and penicillin. Breast augmentation, breast reconstruction, and breast reduction surgery were the most frequently associated breast surgery procedures in this study with infections, with the highest number of infections occurring following breast augmentation with fat grafting, breast reduction surgery, and breast reconstruction with autologous tissue. Various breast plastic surgery procedures have different common pathogens of infection, but the most prevalent are CoNS and S. aureus. Additionally, the majority of the infections in this study were in the early stages. CONCLUSIONS Gram-positive bacteria were the predominant cause of breast plastic surgery infections, and the types of infection strains, the period of infection onset, and the antibiotic susceptibility of prevalent strains varied between breast plastic procedures.
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Affiliation(s)
- Xueshang Su
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jintian Hu
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengli Jiang
- Department of Medical Laboratory, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuanyuan Wu
- Department of Medical Laboratory, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingjing He
- Department of Medical Laboratory, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ximeng Jia
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sien Zhan
- Department of Medical Laboratory, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Jaber TM, Bangash S, Alvarenga AB, Sicari J, DuMont T, Malik K, Bhanot N. Infectious Diseases Specific to Women. Crit Care Nurs Q 2023; 46:417-425. [PMID: 37684737 DOI: 10.1097/cnq.0000000000000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Female patients are at a greater risk for infections such as urinary tract infections and mastitis, as well as complications from abortions/miscarriages, and sexually transmitted infections. This review highlights risk factors, pathogenesis, complications, diagnostic, and treatment modalities associated with the following infections: mastitis, sexually transmitted diseases, postpartum/abortion-related infections, and urinary tract infections.
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Affiliation(s)
- Tariq M Jaber
- Division of Infectious Disease and Critical Care (Drs Jaber, Bangash, and Alvarenga), Division of Pulmonary and Critical Care Medicine (Drs Sicari, DuMont, and Malik), and Division of Infectious Disease (Dr Bhanot), Allegheny Health Network Medicine Institute, Pittsburgh, Pennsylvania
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Min S, Choi J, Na KJ, Hong KY. Infective Costochondritis after Augmentation Mammoplasty: A Rare Case Report and Review of the Literature. Arch Plast Surg 2023; 50:488-491. [PMID: 37808331 PMCID: PMC10556329 DOI: 10.1055/a-2088-2829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/15/2023] [Indexed: 10/10/2023] Open
Abstract
Silicone breast implant insertion is a commonly performed surgical procedure for breast augmentation or reconstruction. Among various postoperative complications, infection is one of the main causes of patient readmission and may ultimately require explantation. We report a case of infective costochondritis after augmentation mammoplasty, which has rarely been reported and is therefore difficult to diagnose. A 36-year-old female visited the clinic for persistent redness, pain, and purulent discharge around the left anteromedial chest, even after breast implant explantation. Magnetic resonance imaging showed abscess formation encircling the left fourth rib and intracartilaginous and bone marrow signal alteration at the left body of the sternum and left fourth rib. En bloc resection of partial rib and adjacent sternum were done and biopsy results confirmed infective costochondritis. Ten months postoperatively, the patient underwent chest wall reconstruction with an artificial bone graft and acellular dermal matrix. As shown in this case, early and aggressive surgical debridement of the infected costal cartilage and sternum should be performed for infective costochondritis. Furthermore, delayed chest wall reconstruction could significantly contribute to the quality of life.
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Affiliation(s)
- Sally Min
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jinil Choi
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kwon Joong Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ki Yong Hong
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Garnier L, Tourasse C, Frobert P, Vaucher R, Perez S, Delay E. [How to manage late periprosthetic fluid collections (seromas) in patients with breast implants?]. ANN CHIR PLAST ESTH 2023; 68:66-76. [PMID: 36266214 DOI: 10.1016/j.anplas.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/18/2022] [Accepted: 09/26/2022] [Indexed: 01/18/2023]
Abstract
The widespread use of silicone implants in reconstructive and aesthetic breast surgery led to an increase in the incidence of breast implant associated anaplastic large cell lymphoma, BIA-ALCL, mainly associated with the use of macro-textured breast implants. BIA-ALCL is a serious complication presenting clinically as a late onset periprosthetic seroma. Thus, its occurrence became an alarming sign feared by most plastic surgeons. Therefore, a good knowledge with respect to early diagnosis, subsequent workup, and treatment is crucial in the management of periprosthetic seroma. The diagnosis of late onset seroma is clinically evident. Although idiopathic seroma is the most common cause, BIA-ALCL should be always eliminated. A complete workup is usually necessary. An ultrasound performed by a radiologist specialized in breast imaging followed by an ultrasound guided puncture is imperative. Consequently, the cytological and the bacteriological analysis will orient us toward the etiology (infectious, neoplastic or mechanical). A standardized management of late periprosthetic seroma does not exist, with various factors are to be taken into consideration. These include the surgeon's experience, the diagnosis, and the medical institution facilities. Although idiopathic seroma is managed by a simple puncture and drainage, other causes may require a surgical procedure with implant removal, capsulotomies, and/or total capsulectomies.
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Affiliation(s)
- L Garnier
- Département de chirurgie plastique et reconstructrice, centre Léon Bérard, Lyon, France
| | - C Tourasse
- Service de radiologie, hôpital privé Jean Mermoz, Lyon, France
| | - P Frobert
- Département de chirurgie plastique et reconstructrice, centre Léon Bérard, Lyon, France
| | - R Vaucher
- Département de chirurgie plastique et reconstructrice, centre Léon Bérard, Lyon, France
| | - S Perez
- Département de chirurgie plastique et reconstructrice, centre Léon Bérard, Lyon, France
| | - E Delay
- Département de chirurgie plastique et reconstructrice, centre Léon Bérard, Lyon, France; Cabinet, 50, rue de la République, 69002 Lyon, France.
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DermACELL Acellular Dermal Matrix in Oncologic Breast Reconstruction: A Cohort Study and Systematic Review. Plast Reconstr Surg Glob Open 2022; 10:e4396. [PMID: 35747252 PMCID: PMC9208874 DOI: 10.1097/gox.0000000000004396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/06/2022] [Indexed: 11/26/2022]
Abstract
Acellular dermal matrices (ADMs) are commonly used in tissue expander and direct-to-implant reconstruction following mastectomy. Few studies have reported outcomes of DermACELL use or compared DermACELL with AlloDerm ADM. This study sought to compare outcomes of DermACELL and AlloDerm in oncologic breast reconstruction and to review the literature reporting outcomes of patients undergoing reconstruction using DermACELL.
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8
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Martin MS, Kebede S, Saad OA, Baker NF, Losken A. Impact of Socioeconomic Status on Breast Reconstruction Outcomes. Ann Plast Surg 2022; 88:S481-S484. [PMID: 35276707 DOI: 10.1097/sap.0000000000003124] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Minority patients and those from low socioeconomic backgrounds are faced with barriers to care regarding breast reconstruction. With this study, we seek to elucidate variances in demographics to determine predictors of complications in implant-based breast reconstruction. METHODS Patients who underwent breast reconstruction with either direct to implant or immediate expander reconstruction by 1 surgeon were identified using the preoperative Breast-Q.Current income statistics available from the US Census Bureau by self-reported zip code were used to determine the median household income (MHI) to stratify differing socioeconomic backgrounds. Demographics were compared with body mass index, comorbidities, overall rate of postoperative complications, rate of implant infection, and type of reconstruction. RESULTS Two hundred ninety-five patients met inclusion criteria. Overall rate of complications and rate of breast implant infection was higher for MHI of less than $50,000 compared with greater than $50,000 (P = 0.043 overall complications 40.20% vs 28.8%) (P = 0.04 implant infection 14.4% vs 7.1%). African American patients had higher body mass index (P = <0.001), rates of HTN (P = <0.001), and diabetes (P = 0.001), and were more likely to have a lower income (P = <0.001). There was, however, no difference in overall complications (P = 0.26), implant infection rate (P = 0.994), or capsular contracture (0.367) based on race. There was no difference in rate of comorbidities between low and high socioeconomic areas. CONCLUSION This cohort demonstrates a higher rate of overall complications and infection in patients with a lower MHI and no difference based on race despite having higher risk factors for complications.Socioeconomic status is a multifaceted barrier to care that must be addressed in the perioperative period to decrease breast implant associated complications.
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Affiliation(s)
- Morgan S Martin
- From the Division of Plastic Surgery, Emory University, Atlanta, GA
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9
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Chen B, Chi G, Li N, Huang L, Mo S. The formation mechanism of the bilayer capsular contracture after an augmentation mammoplasty with a rough‐surface prosthesis and its prevention and treatment. J Cosmet Dermatol 2022; 21:4623-4630. [PMID: 35152532 DOI: 10.1111/jocd.14849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/28/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Bao‐Feng Chen
- Department of Plastic and Cosmetic Surgery Fifth Affiliated Hospital of Guangxi Medical University(Nanning First People's Hospital) Nanning 530022 China
| | - Gang‐Yi Chi
- Department of Plastic and Cosmetic Surgery Fifth Affiliated Hospital of Guangxi Medical University(Nanning First People's Hospital) Nanning 530022 China
| | - Ning Li
- Department of Plastic and Cosmetic Surgery Fifth Affiliated Hospital of Guangxi Medical University(Nanning First People's Hospital) Nanning 530022 China
| | - Lu Huang
- Department of Plastic and Cosmetic Surgery Fifth Affiliated Hospital of Guangxi Medical University(Nanning First People's Hospital) Nanning 530022 China
| | - Si‐Hui Mo
- Department of Plastic and Cosmetic Surgery Fifth Affiliated Hospital of Guangxi Medical University(Nanning First People's Hospital) Nanning 530022 China
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Michalopoulos NV, Frountzas M, Karathanasis P, Theodoropoulos C, Kolia A, Zografos CG, Triantafyllou T, Larentzakis A, Danias N, Zografos GC. Implant infections after breast reconstruction surgery following mastectomy: Experience from a Greek breast unit. Breast Dis 2022; 41:37-44. [PMID: 34334372 DOI: 10.3233/bd-201077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Despite the dominance of implant-based breast reconstruction after mastectomy, during recent years, it has been correlated to some complications. The aim of this study is to present the Greek experience about management of implant infections after breast reconstructions and to investigate the relationship between possible risk factors and breast pocket fluid cultures. METHODS In total, 260 patients underwent implant-based breast reconstruction due to breast cancer in our center from 2016 until 2020. 46 patients, that underwent implant or expander replacement after breast reconstruction due to mastectomy were included in the present study. RESULTS 260 patients underwent breast reconstruction in our center and in 46 (18%) of them an implant replacement was required. 21 patients (8%) presented clinically with an implant infection, but 12 of them (5%) had positive cultures from the breast pocket fluid. On the contrary, 25 patients (10%) presented no clinical signs of implant infection, but 5 of them (2%) had a positive culture. In addition, we demonstrated a correlation between implant infection and positive cultures (p = 0.009), along with an association between chemotherapy before implant placements and negative cultures (p = 0.035). Finally, the most common pathogen was Staphylococcus epidermidis (29%), followed by Escherichia coli (24%) and Staphylococcus aureus (18%). CONCLUSION Implant infection still remains a very serious complication after breast reconstruction surgery. The establishment of a therapeutic protocol, with specific antimicrobial and surgical targets seems as an effective strategy against implant infections.
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Affiliation(s)
- Nikolaos V Michalopoulos
- 1st Department of Propaedeutic Surgery, Medical School, University of Athens, "Hippocratio" General Hospital, Athens, Greece
- 4th Department of Surgery, Medical School, University of Athens, "Attikon" University Hospital, Chaidari, Greece
| | - Maximos Frountzas
- 1st Department of Propaedeutic Surgery, Medical School, University of Athens, "Hippocratio" General Hospital, Athens, Greece
| | - Panagiotis Karathanasis
- 1st Department of Propaedeutic Surgery, Medical School, University of Athens, "Hippocratio" General Hospital, Athens, Greece
| | - Charalampos Theodoropoulos
- 1st Department of Propaedeutic Surgery, Medical School, University of Athens, "Hippocratio" General Hospital, Athens, Greece
| | - Aikaterini Kolia
- 1st Department of Propaedeutic Surgery, Medical School, University of Athens, "Hippocratio" General Hospital, Athens, Greece
| | - Constantinos G Zografos
- 1st Department of Propaedeutic Surgery, Medical School, University of Athens, "Hippocratio" General Hospital, Athens, Greece
| | - Tania Triantafyllou
- 1st Department of Propaedeutic Surgery, Medical School, University of Athens, "Hippocratio" General Hospital, Athens, Greece
| | - Andreas Larentzakis
- 1st Department of Propaedeutic Surgery, Medical School, University of Athens, "Hippocratio" General Hospital, Athens, Greece
| | - Nikolaos Danias
- 4th Department of Surgery, Medical School, University of Athens, "Attikon" University Hospital, Chaidari, Greece
| | - George C Zografos
- 1st Department of Propaedeutic Surgery, Medical School, University of Athens, "Hippocratio" General Hospital, Athens, Greece
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Dartaha R, Brimo Alsaman MZ, Jobran AWM. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac067. [PMID: 35265320 PMCID: PMC8901272 DOI: 10.1093/jscr/rjac067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/15/2022] [Indexed: 11/23/2022] Open
Abstract
Infection following breast augmentation is a rare event with an incidence rate of 1–2.5%. Late onset infections following breast augmentation are very rare. Herein, we present a case of breast implant infection in a 29-year-old female patient who underwent a bilateral augmentation mammoplasty with a silicone gel prosthesis. After 8 uneventful post-operative years, she presented with right-sided signs of breast infection. She initially treated medically but without improvement. Then, she underwent surgical washout and debridement with removal of the bilateral breast implants. Culture demonstrated Staphylococcus aureus. The clinical history and management of this unusual case are described. Because most of the infections occurs in the first few weeks after augmentation mammoplasty, there is a paucity of data about late onset infections. The most common cultured organism in the early infection is S. aureus.
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Affiliation(s)
- Rami Dartaha
- Rambam Hospital, Haifa Private Clinics, Haifa, Palestine
| | - Muhamad Zakaria Brimo Alsaman
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
- Correspondence address. Faculty of Medicine, University of Aleppo, New Aleppo, Aleppo, Syria. Tel: +963944766035; E-mail:
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12
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Rosman CWK, van Dijl JM, Sjollema J. Interactions between the foreign body reaction and Staphylococcus aureus biomaterial-associated infection. Winning strategies in the derby on biomaterial implant surfaces. Crit Rev Microbiol 2021; 48:624-640. [PMID: 34879216 DOI: 10.1080/1040841x.2021.2011132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Biomaterial-associated infections (BAIs) are an increasing problem where antibiotic therapies are often ineffective. The design of novel strategies to prevent or combat infection requires a better understanding of how an implanted foreign body prevents the immune system from eradicating surface-colonizing pathogens. The objective of this review is to chart factors resulting in sub-optimal clearance of Staphylococcus aureus bacteria involved in BAIs. To this end, we first describe three categories of bacterial mechanisms to counter the host immune system around foreign bodies: direct interaction with host cells, modulation of intercellular communication, and evasion of the immune system. These mechanisms take place in a time frame that differentiates sterile foreign body reactions, BAIs, and soft tissue infections. In addition, we identify experimental interventions in S. aureus BAI that may impact infectious mechanisms. Most experimental treatments modulate the host response to infection or alter the course of BAI through implant surface modulation. In conclusion, the first week after implantation and infection is crucial for the establishment of an S. aureus biofilm that resists the local immune reaction and antibiotic treatment. Although established and chronic S. aureus BAI is still treatable and manageable, the focus of interventions should lie on this first period.
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Affiliation(s)
- Colin W K Rosman
- Department of Biomedical Engineering, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Jan Maarten van Dijl
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Jelmer Sjollema
- Department of Biomedical Engineering, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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13
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Daghistani M, Hanawi M, Alturki N. Dormant Pseudomonas aeruginosa infection seven years post-augmentation mastopexy: A case report. Int J Surg Case Rep 2021; 89:106614. [PMID: 34861549 PMCID: PMC8640439 DOI: 10.1016/j.ijscr.2021.106614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction and importance Around 1% of all complications associated with breast implants are attributable to infection, classified as acute, subacute, or late-onset, with late-onset infections being the rarest. Even when symptoms are not obvious, an infection may still be lingering. Sub-clinical presentations have been implicated in the pathophysiology of breast implant capsular contracture. Organisms can establish dormancy through biofilm formation, and can also be idiopathically activated, and present as a late-onset infection, as has been clearly described in the literature with the infamous Enterococcus avium. Case presentation We report the case of a 44-year-old woman who underwent bilateral augmentation mastopexy seven years ago complicated by an acute perioperative infection that was resolved with a full course of antibiotics. She presented to the clinic complaining of left breast pain and swelling accompanied by fever for four days. Ultrasonic imaging showed moderate peri-implant fluid positive for Pseudomonas aeruginosa upon aspiration. The patient therefore underwent bilateral breast exploration and capsulectomy. Clinical discussion We believe that the dormant P. aeruginosa contributed to the capsular contracture and was idiopathically activated, manifesting as a late-onset infection seven years post-augmentation mastopexy. Conclusion To the best of our knowledge, no previous studies or case reports have described a late-onset infection due to idiopathic activation, where dormant P. aeruginosa is isolated from an implant capsule many years after augmentation mastopexy. More studies are required to examine the role of dormant bacteria in capsular contracture and their idiopathic activation considering the consequences on patient outcomes. Capsular contracture is the commonest complication after breast implantation. Subclinical infections are implicated in capsular contracture pathogenesis. Pseudomonas aeuroginosa may cause acute-onset and late-onset infections. Biofilm formation helps bacteria establish dormancy in infected tissues. Dormant bacteria cause capsular contracture and are idiopathically activated.
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Affiliation(s)
- Mamoon Daghistani
- Department of Plastic Surgery, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Maha Hanawi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
| | - Nouf Alturki
- Department of Plastic Surgery, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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14
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Management of Infected Galactocele and Breast Implant with Uninterrupted Breastfeeding. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3943. [PMID: 34804762 PMCID: PMC8601268 DOI: 10.1097/gox.0000000000003943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/24/2021] [Indexed: 11/27/2022]
Abstract
Infected breast implants during lactation present a rare but challenging clinical scenario that may result in early cessation of breastfeeding and unnecessary morbidity to mother and infant. We present the case of a 39-year-old African American primigravid woman with a history of bilateral retropectoral textured implants placed three years prior. Five days after delivering a healthy, full-term infant via cesarean section, she sought evaluation for nipple pain and trauma. She was instructed to use a nipple shield and pump every 2–3 hours in addition to breastfeeding, which resulted in iatrogenic hyperlactation. One week postpartum, the patient was started on antibiotics for presumed mastitis. Ultrasound demonstrated a complex fluid collection at the 12 o’clock periareolar position, as well as peri-implant fluid. She subsequently underwent aspirations of a periareolar complex galactocele and aspirations of peri-implant fluid. She continued on antibiotics without improvement. The patient proceeded to implant removal and definitive drainage of the galactocele at four months postpartum. Throughout her course, the patient provided her infant with exclusive breastmilk, including breastfeeding in the perioperative area of the operating room. This case demonstrates an example of safe surgical removal of infected breast implants and management of an infected galactocele without interruption of breastfeeding.
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15
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Muthusami MA, Green MMJ, Brookes MP, Kasana MI. A novel and cost-effective method of breast implant-pocket salvage after implant infection - Pilot. J Plast Reconstr Aesthet Surg 2021; 75:893-939. [PMID: 34866006 DOI: 10.1016/j.bjps.2021.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/19/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Miss Anitha Muthusami
- Specialty Trainee Registrar (General Surgery) Walsall Manor Hospital, Walsall Healthcare NHS Trust, West Midlands, UK
| | - Mr Matthew J Green
- Consultant Oncoplastic Breast Surgeon, Walsall Manor Hospital, Walsall Healthcare NHS Trust, West Midlands, UK.
| | - Mr Philip Brookes
- Consultant Oncoplastic Breast Surgeon, Walsall Manor Hospital, Walsall Healthcare NHS Trust, West Midlands, UK.
| | - Mr Iqbal Kasana
- Consultant Oncoplastic Breast Surgeon, Walsall Manor Hospital, Walsall Healthcare NHS Trust, West Midlands, UK.
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16
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Teh JSK, Wilke AE, Overstall SM, Teng JC, Chin R, Couper JM, Lo CA, Waring LJ, Sheffield DA. Prototheca wickerhamii breast implant infection after reconstructive surgery: a new level of complexity. Med Mycol Case Rep 2021; 34:22-26. [PMID: 34584835 PMCID: PMC8455647 DOI: 10.1016/j.mmcr.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/07/2021] [Accepted: 08/11/2021] [Indexed: 11/28/2022] Open
Abstract
We report the first published case of Prototheca wickerhamii breast implant infection. This occurred after mastectomy, chemotherapy, radiotherapy, breast reconstruction, implant revisions and breast seroma aspirations and was preceded by polymicrobial infection. Definitive treatment required implant removal and intravenous liposomal amphotericin B. The management of breast prosthesis infections is discussed.
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Affiliation(s)
- Joanne S K Teh
- Department of Perioperative Medicine, Cabrini Health, 181-183 Wattletree Road, Malvern, Victoria, 3144, Australia.,Department of General Medicine, Monash Health, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Amalie E Wilke
- Department of Infectious Diseases, Cabrini Health, 181-183 Wattletree Road, Malvern, Victoria, 3144, Australia
| | - Simon M Overstall
- Department of Plastic Surgery, Cabrini Health, 181-183 Wattletree Road, Malvern, Victoria, 3144, Australia
| | - Jasmine C Teng
- Department of Microbiology, Melbourne Pathology, 103 Victoria Parade, Collingwood, Victoria, 3066, Australia
| | - Ruth Chin
- Department of Infectious Diseases, Cabrini Health, 181-183 Wattletree Road, Malvern, Victoria, 3144, Australia
| | - Jennifer M Couper
- Department of Microbiology, Cabrini Pathology, Cabrini Health, 181-183 Wattletree Road, Malvern, Victoria, 3144, Australia
| | - Christine A Lo
- Department of Pharmacy, Cabrini Health, 181-183 Wattletree Road, Malvern, Victoria, 3144, Australia
| | - Lynette J Waring
- Department of Microbiology, Melbourne Pathology, 103 Victoria Parade, Collingwood, Victoria, 3066, Australia
| | - David A Sheffield
- Department of Infectious Diseases, Cabrini Health, 181-183 Wattletree Road, Malvern, Victoria, 3144, Australia.,Monash Infectious Diseases, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
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17
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Rezende-Pereira G, Albuquerque JP, Souza MC, Nogueira BA, Silva MG, Hirata R, Mattos-Guaraldi AL, Duarte RS, Neves FPG. Biofilm Formation on Breast Implant Surfaces by Major Gram-Positive Bacterial Pathogens. Aesthet Surg J 2021; 41:1144-1151. [PMID: 33378420 DOI: 10.1093/asj/sjaa416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Bacterial biofilm on surfaces of mammary implants is a predisposing factor for several outcomes. Because Gram-positive bacteria are potential agents of biomaterial-associated infections (BAIs), their abilities to form biofilm on breast implants should be elucidated. OBJECTIVES The aim of this study was to evaluate biofilm formation on different mammary prosthesis surfaces by major Gram-positive bacterial pathogens involved in BAIs. METHODS We initially evaluated biofilm formation on polystyrene plates with and without fibrinogen or collagen for 1 reference strain and 1 clinical isolate of Enterococcus faecalis, Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus pyogenes. We also tested the ability of clinical isolates to form biofilm on 4 different implant surfaces: polyurethane foam and smooth, microtextured, and standard textured silicone. Biofilm structure and cell viability were observed by scanning electron microscopy and confocal laser scanning microscopy. RESULTS All strains showed strong biofilm formation on polystyrene. After fibrinogen or collagen treatment, biofilm formation varied. With fibrinogen, reference strains of S. aureus and S. pyogenes increased biofilm formation (P < 0.05). Reference strains of all species and the clinical isolate of S. pyogenes increased biofilm formation after collagen treatment (P < 0.05). In general, S. aureus showed higher capacity to produce biofilm. Scanning electron microscopy showed that biofilm attached to all surfaces tested, with the presence of extracellular polymeric substances and voids. Viable cells were more frequent for E. faecalis and S. pyogenes. CONCLUSIONS All species produced biofilm on all prosthesis surfaces and under different conditions. Micrographies indicated thicker bacterial biofilm formation on microtextured and/or standard textured silicone by all species, except E. faecalis.
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Affiliation(s)
| | | | - Monica C Souza
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Barbara A Nogueira
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marlei G Silva
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Raphael Hirata
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Ana L Mattos-Guaraldi
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Rafael S Duarte
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Felipe P G Neves
- Instituto Biomédico, Universidade Federal Fluminense, Niterói, RJ, Brazil
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18
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Mesa F, Cataño S, Tuberquia O. Study of Infections in Breast Augmentation Surgery with Implants in 9,691 Patients over 5 Years. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3752. [PMID: 34386312 PMCID: PMC8354627 DOI: 10.1097/gox.0000000000003752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/22/2021] [Indexed: 11/30/2022]
Abstract
Background: This study presents a review of a single retrospective cohort of patients who underwent surgery for breast augmentation with implants, during a period of 5 years, aged 17–60 years (mean 32 years), in a single institution, IQ Interquirofanos, a private clinic in the city of Medellín, Colombia. Method: A single retrospective cohort study was carried out, in which the database of patients who underwent breast augmentation with implants during 5 years was analyzed. Results: In this period of time, 9,691 female patients and a total of 19,382 breast implants implanted by 66 plastic surgeons underwent breast augmentation surgery. All the breast prostheses used were round, made of silicone gel in all cases and textured in most of them. 37 patients presented infection at the surgical site, 33 were unilateral and four bilateral, with an incidence of 0.38% per patient. The form of presentation was cellulitis in 46% of the cases, followed by seroma and hematoma in 25%. It was found that there is no difference in the incidence of infection between patients with breast augmentation for the first time and implant replacement due to different causes (OR 1.25, 95% CI 0.66–2.3, P = 0.49). One of the surgeons was associated with 37.8% of the infections and was found to be an asymptomatic carrier of Staphylococcus aureus, requiring medical treatment. The relationship of the infection with the treating surgeons was also analyzed and it was found that there is an association between these two variables. The infection appeared in the first 2 weeks after surgery in 92.7% of the cases. The main isolated germ was Staphylococcus aureus, followed by Pseudomona aeruginosa, Staphylococcus epidermidis, Serratia marcescens, Candida parapsilosis, Enterobacter cloacae, and a patient with Mycobacterium fortuitum in both breasts. Of the 37 patients with infection, six breast implants were required to be explanted in five patients, who were repositioned 3–6 months later without complications. Conclusions: Incidence of infection in augmentation mammoplasty with implants was 0.38% in patients infected in one or both breasts, during 5 years. There is a relationship between the presence of breast infection and the surgeon who performed the intervention. The most frequent germs found in breast implant infections continue to be Staphylococcus aureus followed by Pseudomonas aeruginosa.
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Affiliation(s)
| | - Sebastian Cataño
- CES University, Medellin, Colombia.,IQ Interquirofanos, Medellin, Colombia
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19
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Manzour N, Vázquez-Vicente D, Carriles I, Boria F, Chacon E, Chiva L. Intra-operative radiation therapy after a total lateral extended infralevator exenteration for recurrent cervical cancer. Int J Gynecol Cancer 2021; 31:1188-1189. [PMID: 34031133 DOI: 10.1136/ijgc-2021-002592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Nabil Manzour
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | | | - Isabel Carriles
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
| | - Felix Boria
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
| | - Enrique Chacon
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Luis Chiva
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
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20
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Nishikubo M, Nasu S, Maruoka H, Kawabata T, Ikeda M, Nishioka H. Sequential breast implant infections due to Campylobacter fetus subsp. fetus. J Infect Chemother 2021; 27:1080-1083. [PMID: 33563526 DOI: 10.1016/j.jiac.2021.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 11/18/2022]
Abstract
Campylobacter jejuni and Campylobacter coli are the leading causes of bacterial intestinal infections worldwide, while Campylobacter fetus subsp. fetus (C. fetus) has been reported to cause extraintestinal infections, including medical device implant infections. However, breast implant infections have rarely been reported. We describe the case of a 64-year-old woman with breast implant infection and vertebral osteomyelitis due to C. fetus. The patient recovered by surgical removal of the infected left implant and was treated with antibiotics for 6 weeks. However, two weeks after the completion of antibiotics, she experienced an infection in the right implant due to C. fetus, which had developed quinolone resistance with a G91T mutation during the treatment course. This case showed that C. fetus can cause breast implant infections, and although the infection may appear to be unilateral initially, the possibility of sequential contralateral infection should be considered.
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Affiliation(s)
- Masashi Nishikubo
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan; Department of General Internal Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Seiko Nasu
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Hayato Maruoka
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Tomoya Kawabata
- Department of Plastic Surgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Mika Ikeda
- Department of Plastic Surgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Hiroaki Nishioka
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan.
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21
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Segal N, Polcz VE, McKean JA, Kariyawasam V, Carson JS, Fahy BG. Pseudomonal Meningoencephalitis With Ventriculitis Secondary to Bacteremia in a Burn Patient: A Novel Case. J Burn Care Res 2021; 42:832-835. [PMID: 33484564 DOI: 10.1093/jbcr/irab016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Burn patients with large burn surface area involvement are at increased risk of infection due to the presence of large wounds, multiple surgeries, prolonged intensive care unit admission, and immunosuppression. Pseudomonas aeruginosa is the most commonly isolated organism in this population. Even with frequent infections in the burn population, meningitis and encephalitis are rare, and ventriculitis is exceptional. We report the case of a 66-year-old woman who developed P. aeruginosa bacteremia during her hospital course, causing secondary meningoencephalitis with ventriculitis. She was admitted for partial- and full-thickness burns affecting the neck, chest, abdomen, upper medial arms, and bilateral anteromedial thighs for an estimated 20% total body surface area burn. She met sepsis criteria and broad-spectrum antimicrobial coverage was initiated. Magnetic resonance imaging of the brain, performed for altered mental status, revealed meningitis and ventriculitis. Cerebrospinal fluid analysis demonstrated findings consistent with bacterial meningitis, with cultures positive for P. aeruginosa. Serial neuroimaging with computerized tomography revealed new areas of ischemia concerning for septic emboli. In the presence of altered mental status and fever of unknown origin, workup should remain broad. Even in the presence of another source, it is important to keep an open mind for the rarer intracerebral infection as it requires different management, including urgent evaluation of antibiotic selection and dosing to ensure central nervous system penetration, and neurosurgical evaluation.
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Affiliation(s)
- Nicolas Segal
- Division of Critical Care Medicine, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, USA
| | - Valerie E Polcz
- Department of Surgery, University of Florida College of Medicine, Gainesville, USA
| | - Jordan A McKean
- Department of Surgery, University of Florida College of Medicine, Gainesville, USA
| | - Vidhu Kariyawasam
- Division of Infectious Disease and Global Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Joshua S Carson
- Department of Surgery, University of Florida College of Medicine, Gainesville, USA
| | - Brenda G Fahy
- Division of Critical Care Medicine, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, USA
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22
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Frisell A, Lagergren J, Halle M, de Boniface J. Risk factors for implant failure following revision surgery in breast cancer patients with a previous immediate implant-based breast reconstruction. Breast Cancer Res Treat 2020; 184:977-984. [PMID: 32920741 PMCID: PMC7655578 DOI: 10.1007/s10549-020-05911-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/01/2020] [Indexed: 11/25/2022]
Abstract
Purpose The aim of the current study was to evaluate risk factors and timing of revision surgery following immediate implant-based breast reconstruction (IBR). Methods This retrospective cohort included women with a previous therapeutic mastectomy and implant-based IBR who had undergone implant revision surgery between 2005 and 2015. Data were collected by medical chart review and registered in the Stockholm Breast Reconstruction Database. The primary endpoint was implant removal due to surgical complications, i.e. implant failure. Results The cohort consisted of 475 women with 707 revisions in 542 breasts. Overall, 33 implants were removed due to complications. The implant failure rate (4.7%) was lower without RT (2.4%) compared to RT administered after mastectomy (7.5%) and prior to IBR (6.5%) (p = 0.007). While post-mastectomy RT (OR 3.39, 95% CI 1.53–7.53), smoking (OR 3.90, 95% CI 1.76–8.65) and diabetes (OR 5.40, 95% CI 1.05–27.85) were confirmed as risk factors, time from completion of RT (> 9 months, 6–9 months, < 6 months) was not (OR 3.17, 95% CI 0.78–12.80, and OR 0.74, 95% CI 0.20–2.71). Additional risk factors were a previous axillary clearance (OR 4.91, 95% CI 2.09–11.53) and a history of a post-IBR infection (OR 15.52, 95% CI 4.15–58.01, and OR 12.93, 95% CI 3.04–55.12, for oral and intravenous antibiotics, respectively). Conclusions Previous axillary clearance and a history of post-IBR infection emerged as novel risk factors for implant failure after revision surgery. While known risk factors were confirmed, time elapsed from RT completion to revision surgery did not influence the outcome in this analysis.
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Affiliation(s)
- A Frisell
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77, Solna, Stockholm, Sweden.
| | - J Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77, Solna, Stockholm, Sweden.,Department of Surgery, Capio St. Göran's Hospital, Stockholm, Sweden
| | - M Halle
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77, Solna, Stockholm, Sweden.,Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - J de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77, Solna, Stockholm, Sweden.,Department of Surgery, Capio St. Göran's Hospital, Stockholm, Sweden
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23
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Milazzo M, Gallone G, Marcello E, Mariniello MD, Bruschini L, Roy I, Danti S. Biodegradable Polymeric Micro/Nano-Structures with Intrinsic Antifouling/Antimicrobial Properties: Relevance in Damaged Skin and Other Biomedical Applications. J Funct Biomater 2020; 11:jfb11030060. [PMID: 32825113 PMCID: PMC7563177 DOI: 10.3390/jfb11030060] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/07/2020] [Accepted: 08/12/2020] [Indexed: 12/16/2022] Open
Abstract
Bacterial colonization of implanted biomedical devices is the main cause of healthcare-associated infections, estimated to be 8.8 million per year in Europe. Many infections originate from damaged skin, which lets microorganisms exploit injuries and surgical accesses as passageways to reach the implant site and inner organs. Therefore, an effective treatment of skin damage is highly desirable for the success of many biomaterial-related surgical procedures. Due to gained resistance to antibiotics, new antibacterial treatments are becoming vital to control nosocomial infections arising as surgical and post-surgical complications. Surface coatings can avoid biofouling and bacterial colonization thanks to biomaterial inherent properties (e.g., super hydrophobicity), specifically without using drugs, which may cause bacterial resistance. The focus of this review is to highlight the emerging role of degradable polymeric micro- and nano-structures that show intrinsic antifouling and antimicrobial properties, with a special outlook towards biomedical applications dealing with skin and skin damage. The intrinsic properties owned by the biomaterials encompass three main categories: (1) physical–mechanical, (2) chemical, and (3) electrostatic. Clinical relevance in ear prostheses and breast implants is reported. Collecting and discussing the updated outcomes in this field would help the development of better performing biomaterial-based antimicrobial strategies, which are useful to prevent infections.
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Affiliation(s)
- Mario Milazzo
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA 02142, USA
- Correspondence: (M.M.); (S.D.)
| | - Giuseppe Gallone
- Department of Civil and Industrial Engineering, University of Pisa, 56126 Pisa, Italy;
| | - Elena Marcello
- School of Life Sciences, University of Westminster, London W1W 6UW, UK;
| | - Maria Donatella Mariniello
- Doctoral School in Clinical and Translational Sciences, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, via Savi 10, 56126 Pisa, Italy;
| | - Luca Bruschini
- Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, University of Pisa, via Savi 10, 56126 Pisa, Italy;
| | - Ipsita Roy
- Department of Materials Science and Engineering, Faculty of Engineering, University of Sheffield, Sheffield S1 3JD, UK;
| | - Serena Danti
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA 02142, USA
- Department of Civil and Industrial Engineering, University of Pisa, 56126 Pisa, Italy;
- Doctoral School in Clinical and Translational Sciences, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, via Savi 10, 56126 Pisa, Italy;
- Correspondence: (M.M.); (S.D.)
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24
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Aspergillus fumigatus Spores Are Not Able to Penetrate Silicone Breast Implant Shells. Ann Plast Surg 2019; 85:306-309. [PMID: 31800548 DOI: 10.1097/sap.0000000000002135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Bacterial contamination is hypothesized to be one reason for the development of capsular contracture after alloplastic breast reconstruction using silicone breast implants. The role of fungal colonization or infection in this context as well as the question if microorganisms can penetrate the shell of silicone breast implants remains an unresolved question to date. Therefore, the aim of this study was to assess whether fungal spores are able to penetrate the shell of silicone implants. MATERIALS AND METHODS In an experimental in vitro setup with different arrangements of growth compartments, silicone chambers were placed in culture dishes filled with Aspergillus minimal medium or liquid culture medium. Inoculation was performed with conidia of Aspergillus fumigatus and incubated for seven days. On a daily basis, plates were inspected for conidial germination and hyphal growth. RESULTS In none of the different experimental settings nutrients or hyphae of Aspergillus fumigatus were able to penetrate the silicone material. CONCLUSIONS Fungal spores and hyphae do not permeate through an intact silicone shell used in breast implants; thus, the silicone material serves as an impenetrable barrier.
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25
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Li M, Tang S. [Analysis of risk factors related to periprosthetic infection after breast augmentation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:889-893. [PMID: 31298009 DOI: 10.7507/1002-1892.201901093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the risk factors related to periprosthetic infection after breast augmentation, and to provide a basis for reducing the risk of postoperative infection. Methods A total of 1 056 female patients who underwent breast augmentation between January 2010 and January 2018 were analyzed retrospectively. The patients were 20 to 44 years old (mean, 31.6 years). The body mass index (BMI) was 19.0-31.1 kg/m 2, with an average of 24.47 kg/m 2. According to the periprosthetic infection standard of the United States Centers for Disease Control and Prevention (CDC), the patients were divided into infection group and non-infection group. Age, BMI, diabetes, previous history of immunosuppression, history of smoking, previous history of breast surgery, previous history of mastitis, combined with active dermatitis, surgical approach, the type and shape of breast prosthesis, implant in the different layers, combined with mastopexy, operation time, postoperative antibiotic time, postoperative breast crash, and postoperative potential infection surgery were analyzed by univariate analysis. The influencing factors of prosthetic infection were screened by logistic regression. Results Periprosthetic infection occurred in 60 cases after operation, and the infection rate was 5.68%. Among them, 11 cases were acute infection, 33 cases were subacute infection, 16 cases were delayed infection, and 20 cases were positive in bacterial culture. Postoperative breast crash occurred in 114 cases. Univariate analysis showed that diabetes, previous history of immunosuppression, history of smoking, previous history of mastitis, postoperative breast crash, postoperative potential infection surgery, and combined with breast suspension were the influencing factors of postoperative periprosthetic infection ( P<0.05). Multivariate analysis showed that diabetes, history of smoking, and postoperative breast crash were the risk factors of periprosthetic infection ( P<0.05). Conclusion Diabetes, smoking, and postoperative breast crash are the risk factors of periprosthetic infection after breast augmentation.
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Affiliation(s)
- Min Li
- Plastic Surgery Hospital of Weifang Medical College, Weifang Shandong, 261041, P.R.China
| | - Shengjian Tang
- Plastic Surgery Hospital of Weifang Medical College, Weifang Shandong, 261041,
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26
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Cutibacterium avidum: A rare but expected agent of breast implant infection. IDCases 2019; 17:e00546. [PMID: 31110944 PMCID: PMC6510956 DOI: 10.1016/j.idcr.2019.e00546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/28/2019] [Accepted: 04/28/2019] [Indexed: 11/30/2022] Open
Abstract
Cutibacterium avidum previously was considered of low pathogenicity. C. avidum is recognized as a causative organism of surgical site infections. C. avidum should not be disregarded if there are clinical signs of infection.
Cutibacterium avidum is largely commensal and part of the skin microbiota, recently recognized as a pathogen that causes surgical site infections, especially in the presence of implants or medical devices. We present a 50-year-old woman with Cutibacterium avidum infection associated with breast implant augmentation, which required the removal of the implants to achieve the cure. As a skin commensal, Cutibacterium avidum previously was considered of low pathogenicity, but is now recognized as a causative organism of serious spontaneous and surgical site infections. It should not be routinely disregarded without further investigation, particularly if clinical signs of infection are present.
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27
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Corcione S, Lupia T, De Rosa FG. Skin and soft tissue infections after breast surgery. Curr Opin Infect Dis 2019; 32:87-94. [PMID: 30695000 DOI: 10.1097/qco.0000000000000531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Breast surgery is considered a clean surgical procedure; nevertheless, infection rates are often higher than those reported after other similarly considered clean surgeries (e.g., thyroid, hernia). Acute bacterial skin and soft tissue infections, mostly surgical site infections and implant-associated infections are commonest events that could complicate postoperative care. RECENT FINDINGS Risk of infection is closely related to surgery procedure itself and patients host factors. Gram-positive bacteria with pattern of antimicrobial resistance are increasingly isolated and before today less frequent causes such as gram negative and mycobacteria infections. Impact of postoperative complications is underestimated and lacking an appropriate care and education for local and systemic management. SUMMARY We report the current evidence on the management of infections after breast surgery. New drugs options for methicillin-resistant Staphylococcus aureus and other gram positive should have a place in this setting. Stewardship activities aiming at reducing infections risks with the correct considerations of host, microbiological and surgical risk factors.
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Affiliation(s)
- Silvia Corcione
- Department of Medical Sciences, University of Turin, City of Health and Sciences, Turin, Italy
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