Delayed Silicone Breast Implant Infection With Myc

Authors: Wirth Garrett A Brenner Kevin A Sundine Michael J

Publish Date: 2007/03/01

Volume: 27, Issue: 2, Pages: 167-171

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Abstract

Garrett A Wirth Kevin A Brenner Michael J Sundine Delayed Silicone Breast Implant Infection With Mycobacterium aviumintracellulare Aesthetic Surgery Journal Volume 27 Issue 2 March 2007 Pages 167–171 https//doiorg/101016/jasj200612013Mycobacterial breast implant infection is a rare complication after augmentation mammaplasty A review of the literature demonstrates multiple examples of breast implant infection with Mycobacterium fortuitum but only rare discussion of Mycobacterium aviumintracellulare MAC The authors report an unusual case of MAC breast implant infection in a patient with a complex surgical historyThe authors present a complex case history of a patient who underwent several operations including mastectomy transverse rectus abdominis myocutaneous TRAM reconstruction lobectomy for pneumonia with placement of a latissimus dorsi muscle flap and ultimately development of a very unusual Mycobacterium aviumintracellulare contralateral breast implant infection The current appropriate options and considerations for evaluation and treatment of suspicious breast implant infections are presentedAesthetic breast augmentation carries with it a distinct and wellknown possibility of infection Although the risk of infection typically is very low when it occurs the physical physiological and psychological sequelae can be devastating Before the advent of breast implants attempts at breast augmentation with silicone injections into breast parenchyma were known to cause chronic breast abscess with an incidence of 121 Currently most breast augmentation surgeons use either silicone gel–filled or saline solution–filled implants Despite careful attention to sterile technique the overall incidence of implant infection remains at 1 to 4 annually after augmentation mammaplasty2 and 2 to 6 annually after breast reconstruction procedures3The most common cause of infection is bacterial in nature However when conservative treatment of postimplantation cellulitis is used fungal and mycobacterial superinfections can sometimes ensue Although rare the literature does report both isolated and clustered cases of mycobacterial infections24–10 The vast majority of cases of mycobacterial infections that have been associated with breast implants are due to Mycobacterium fortuitum but cases of Mycobacterium chelonae9 and one case of Mycobacterium aviumintracellulare10 have been reported as well The authors present this case report of a patient who had development of a mycobacterial breast implant infection after a cascade of concomitant medical problems and surgical interventions over a 2year courseThe patient was a 44yearold Filipino woman with a history of appendectomy as a child bilateral breast augmentation with silicone gel–filled implants in 1987 and rhinoplasty later that same year The patient had an intracapsular implant rupture on the left side in 1997 that was diagnosed by ultrasound criteria She chose to keep the implants in place for personal reasonsIn October 2002 she was hospitalized and treated for M aviumintracellulare MAC–related pneumonia In May 2002 the patient noted for the first time an episode of bloody discharge from her right nipple This was never brought to medical attention In January 2003 the patient was admitted to the University of California–Irvine Medical Center as a transfer for workup of fevers chills and a productive cough A right breast mass was discovered during her admission physical examinationBiopsy of this lesion revealed a pathologic diagnosis of infiltrating ductal carcinoma The patient had a palpable mass in the left axilla as well but underwent a metastatic workup that was otherwise negative for distant disease She then underwent left axillary lymph node sampling for staging purposes that was also negative for carcinoma Her workup also revealed a nearly obstructing lesion in the upper lobe of her left lung that was biopsynegative for tumor and was thought to be caused by a MAC infection She was treated medically with rifampin azithromycin and levofloxacin Levaquin to gain control of the MAC infectionDuring the same admission the patient underwent a right modified radical mastectomy and pedicled TRAM flap reconstruction on January 24 2003 The right silicone gel–filled breast implant was removed during this operation Although the left implant had a known intracapsular rupture it was left in place with the understanding that it would be removed in the future during planned staged revision surgery to correct breast asymmetry Final pathologic study of the right breast cancer showed mixed invasive lobular carcinoma 90 and invasive ductal carcinoma 10 estrogen receptor positive progesterone receptor positive Her2neu positive and P53 negative Two of 17 lymph nodes were involved with disease Her final stage was T4 N1 M0 Postmastectomy treatment was followed by radiation therapy and chemotherapy

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