Author(s): Javier Bravo MD, Juan Miguel Pérez MD, Alejandro Ruiz, Maria Paula Fernandez MD, Adriana Parra MD and Alfredo Atencia MD

Abstract: Breast implant extrusion is a rare but serious complication following cosmetic or reconstructive breast surgery. It is usually associated with infection, tissue necrosis, and wound tension. Systemic inflammatory diseases, such as Crohn's disease, increase the risk of poor wound healing and postoperative infection. This report describes a case of a 38-year-old woman from Puerto Rico with a history of Crohn's disease who underwent bilateral breast augmentation with mastopexy in Bogotá, Colombia. The initial postoperative period was uneventful; at two weeks, the skin was intact with no implant exposure. The patient returned to Puerto Rico, where she subsequently developed wound drainage. A culture revealed Pseudomonas aeruginosa sensitive to all antipseudomonal antibiotics tested. Upon returning to Colombia, she presented with complete extrusion of the left breast implant, with necrotic margins and purulent exudate. A new culture revealed coinfection with extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae and Pseudomonas aeruginosa. The implant was removed on postoperative day 66, and the wound was temporarily covered with sterile dressings. The patient completed a 14-day course of intravenous meropenem, followed by local wound care. One month later, during the surgical evaluation for breast reconstruction, it was determined that a new implant could not be placed due to insufficient soft tissue coverage. Therefore, reconstruction with a local flap advancement was planned. It was concluded that the combination of extensive soft tissue loss, polymicrobial infection, and underlying Crohn's disease contraindicates immediate reimplantation. Complete explantation, along with targeted antibiotic therapy and delayed reconstruction, constitutes the safest strategy to minimize recurrence and achieve optimal long-term aesthetic results.

DOI: 10.22271/27081494.2025.v7.i2e.239

Pages: 326-332 | Views: 88 | Downloads: 31

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