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193 Articles Related Infection in breast implants

The Lancet Infectious Diseases, Volume 5, Issue 8, August 2005, Pages 462-463

C Vinh, M Embil

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aSection of Infectious Diseases, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

Available online 25 July 2005.

Referred to by: Infection in breast implants – Authors' reply

The Lancet Infectious Diseases, Volume 5, Issue 8, August 2005, Page 463

Didier Pittet, Rohner, Brigitte Pittet

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Summary

There has been a marked increase in thefrequency with which breast prosthesis are being used, both forreconstructive and cosmetic purposes. Although breast implant-relatedinfections are uncommon, they are typically caused by bacterial skinflora, specifically Staphylococcus aureusand the coagulase negative staphylococci. There have been infrequentreports of breast implant infection caused by the atypicalmycobacteria. This report summarizes the case of a young female whounderwent augmentation mammoplasty who presented shortly thereafterwith clinical evidence of an infected breast prosthesis. Despite aprotracted course of empiric antibiotic therapy and multiple surgicalinterventions, she failed to improve. Additional microbiologicinvestigations allowed for a diagnosis of Mycobacterium fortuitumgroup breast implant infection to be established. A prolonged course ofanti-mycobacterial therapy, based upon susceptibility results, allowedfor eradication of the infection and subsequent successfulre-implantation of the prosthesis.

Case Report Granulicatella adiacens breast implant-associated infection

L. del Pozoa, b, , , , Emilio -Quetglasa, Silvia Hernaezb, Serrerab, Marta Alonsob, Pinac, Leivab and Ramon Azanzaa

aInfectious Diseases Division, Universitary Hospital of Navarra, 31080 Pamplona, Spain bDepartment of Clinical Microbiology, Universitary Hospital of Navarra, 31080 Pamplona, Spain cDepartment of Radiology, Universitary Hospital of Navarra, 31080 Pamplona, Spain

Received 2 November 2007;

accepted 5 December 2007.

Available online 21 February 2008.

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Abstract

The 1st reported case of breast implant-associated infection due to Granulicatella adiacens, formerly known as nutritionally variant streptococci, Streptococcus adiacens, and Abiotrophia adiacens is presented. Microbiology and previously reported cases of infections by this organism are reviewed.

Mycobacterial breast implant infection is a rare complication afteraugmentation mammaplasty. A review of the literature demonstratesmultiple examples of breast implant infection with Mycobacterium fortuitum, but only rare discussion of Mycobacterium avium-intracellulare (MAC). The authors report an unusual case of MAC breast implant infection in a patient with a complex surgical history.

Summary

Infection is the leading cause ofmorbidity that occurs after breast implantation and complicates2·0–2·5% of interventions in most case series. Two-thirds of infectionsdevelop within the acute post-operative period, whereas some infectionsmay develop years or even decades after surgery. Infection rates arehigher after breast reconstruction and subsequent implantation thanafter breast augmentation. Risk factors for infection associated withbreast implantation have not been carefully assessed in prospectivestudies with long-term follow-up. Surgical technique and the patient'sunderlying condition are the most important determinants. Inparticular, breast reconstruction after mastectomy and radiotherapy forcancer is associated with a higher risk for infection. The origin ofinfection in women with implants remains difficult to determine, butpotential sources include a contaminated implant, contaminated saline,the surgery itself or the surgical environment, the patient's skin ormammary ducts, or, as suggested by many reports, seeding of the implantfrom remote infection sites. Late infection usually results fromsecondary bacteraemia or an invasive procedure at a location other thanbreasts. Diagnostic and management strategies are proposed and thevalue of peri-operative surgical prophylaxis is revisited. The currenthypothesis of the possible role of low-grade or subclinical infectionin the origin of capsular contracture is also reviewed.

Summary

Fungal infection of breast implants is arare complication. Growth of fungi within the lumen of saline-filledimplants has previously been demonstrated in laboratory studies,however, clinical infections are rare. We report a case of Aspergillus flavusgrowth within and around a saline-filled breast implant that wasinserted 18 months previously. This was successfully treated withimplant removal and wound irrigation. Possible routes of microbialcontamination as well as survival mechanisms of organisms withinsaline-filled implants are discussed. This case reiterates that thesilicone envelope of a saline-filled implant is selectively permeableand we believe this is instrumental in facilitating intraluminalmicrobial growth. This also emphasises the importance of stringentasepsis when dealing with saline-filled breast implants includingavoiding contamination of the saline filling fluid.

Summary

We investigated an outbreak caused bynon-tuberculous mycobacteria (NTM) related to breast implant surgery inthe city of Campinas, Brazil, by means of a retrospective cohort andmolecular epidemiological study. A total of 492 records of individualshaving breast surgery in 12 hospitals were evaluated. Twelve isolateswere analysed using four different molecular typing methods. There were14 confirmed cases, 14 possible cases and one probable case. Oneprobable, nine possible and 12 confirmed cases were included in acohort study; all occurred in eight of the hospitals and the confirmedcases in five. Univariate analysis showed that patients who had hadbreast reconstruction surgery in hospitals A and B were more likely tohave NTM infections. No risk factor was independently associated withNTM infection in the multivariate model. The isolates obtained frompatients at each hospital showed different molecular patterns,excluding isolates from hospital C that repeatedly showed the samegenotype for approximately one year. In conclusion, this outbreak wascaused by polyclonal strains at different institutions, and in onehospital a unique genotype caused most cases. No specific risk factorswere found.

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