Elsevier

Journal of Infection

Volume 52, Issue 3, March 2006, Pages e63-e67
Journal of Infection

Case Report
Breast implant infection with Mycobacterium fortuitum group: Report of case and review

https://doi.org/10.1016/j.jinf.2005.07.004Get rights and content

Summary

There has been a marked increase in the frequency with which breast prosthesis are being used, both for reconstructive and cosmetic purposes. Although breast implant-related infections are uncommon, they are typically caused by bacterial skin flora, specifically Staphylococcus aureus and the coagulase negative staphylococci. There have been infrequent reports of breast implant infection caused by the atypical mycobacteria. This report summarizes the case of a young female who underwent augmentation mammoplasty who presented shortly thereafter with clinical evidence of an infected breast prosthesis. Despite a protracted course of empiric antibiotic therapy and multiple surgical interventions, she failed to improve. Additional microbiologic investigations allowed for a diagnosis of Mycobacterium fortuitum group breast implant infection to be established. A prolonged course of anti-mycobacterial therapy, based upon susceptibility results, allowed for eradication of the infection and subsequent successful re-implantation of the prosthesis.

Introduction

Breast implant-related infections, albeit uncommon, are typically caused by bacterial skin flora, specifically Staphylococcus aureus and coagulase-negative staphylococci, introduced at the time of surgery.1, 2 Infections caused by mycobacteria, however, are uncommon, but are being increasingly reported.2, 3, 4, 5, 6 Of breast implant infections caused by such pathogens, the non-pigmented, rapidly growing members of the Mycobacterium fortuitum complex are the most frequently reported.2, 6, 7, 8, 9 We report a case of a female who underwent augmentation mammoplasty and presented approx. 1 month later with clinical evidence of an infected breast prosthesis. The complexities established in the diagnosis and need for a thorough and accurate microbiologic evaluation are summarized in the case report and discussion that ensue.

Section snippets

Case report

A 27-year-old healthy female underwent bilateral augmentation mammoplasty for hypomastia and ptosis. The 480 cm3 smooth implants were filled to a capacity of 510 cm3 and placed subglandularly, using inframammary incisions. At the time of surgery, each pocket was irrigated with copious amounts of a mixture of bacitracin in saline. One month after the procedure, the patient developed sudden onset of pain and swelling of the right breast with an associated sensation of fever, which resolved within 1

Discussion

Breast prostheses are being increasingly used, both for cosmetic and reconstructive purposes.10, 11 These procedures, like any other surgery, may be complicated by infections involving the operative area. Although bacteria such as S. aureus and coagulase-negative staphylococci are the most common cause of surgical site infections,1 including cosmetic surgeries such as augmentation mammoplasty,2, 3 this case highlights the emergence of mycobacteria as pathogens associated with breast implant

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