Autologous fat transplantation and delayed silicone implant insertion in a case of Mycobacterium avium breast infection.
BACKGROUND
Infection after breast augmentation is uncommon, occurring in 1-3% of cases. 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.


METHODS
This report summarizes the case of a female patient who was infected by Mycobacterium avium after undergoing augmentation mammoplasty. This is the second case reported in the literature. Conservative recommendations include antibiotic therapy and removal of the implant until resolution of the infection or until healing of the wound. Salvage methods include one or more of the following: antibiotic therapy, debridement, curettage, pulse lavage, capsulectomy, device exchange, primary closure, and/or flap coverage.


RESULTS
After removal of the implant and antibiotic therapy, autologous fat transplantation for correction of breast tissue depressions caused by the mycobacterium infection was done. Delayed bilateral breast augmentation by inserting polyurethane-covered silicone implants in subpectoral position and round block mastopexy to resect the periareolar scars were performed.


CONCLUSIONS
Although this kind of complication has significantly compromised the aimed result and has caused frustration to both the patient and the physicians involved, we believe that the combination of autologous fat transplantation and delayed silicone implant insertion can be a safe strategy and can produce an acceptable aesthetic result.
Pereira
Luiz Haroldo
LH
Department of Plastic Surgery, Luiz Haroldo Clinic, Rua Xavier da Silveira 45/206, 22061-010 Rio de Janeiro, Brazil. haroldo@unisys.com.br
Sterodimas
Aris
A
D000273:Adipose Tissue / Q000637:transplantation*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001941:Breast Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D019928:Breast Implantation / Q000379:methods; D018427:Breast Implants / Q000009:adverse effects*; D017291:Clarithromycin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009162:Mycobacterium avium / Q000302:isolation & purification; D015270:Mycobacterium avium-intracellulare Infection / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D011475:Prosthesis Failure; D012086:Reoperation; D020034:Silicone Gels; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D020034:Silicone Gels; D017291:Clarithromycin