Oral Presentation New Zealand Association of Plastic Surgeons Annual Scientific Meeting

A rare and recurrent case of acute fungal breast implant infection (1782)

Brodie J M de Gouw 1 , Emma Littlehales 1 , Patrick Lyall 1
  1. Plastic and Reconstructive Surgery, Dunedin Hospital, Dunedin, Otago, New Zealand

Introduction

Breast implant infection is seen in 1.1-2.5% of patients1, but fungal infection is rare. We report an acute left breast tissue expander infection from Scedosporium apiospermum

Case

A 53-year-old Māori female underwent bilateral risk reducing mastectomies and immediate implant-based reconstruction with a dermofascial sling. She presented acutely unwell on the 25th postoperative day with a left sided seroma that was drained.  Aspirates cultured Scedosporium apiospermum and she proceeded for left tissue expander explantation and washout of the expander pocket. She was treated with 3 months of voriconazole with clinical resolution. Eighteen days after finishing treatment she represented with malaise, left chest wall swelling and discomfort. An ultrasound of the left chest wall showed oedema with no collection. Three weeks later she developed an open wound of the left mastectomy scar and subsequently returned to theatre for a washout and debridement where Scedosporium apiospermum was isolated. She had a further 5 months of voriconazole treatment.

Discussion

Scedosporium apiospermum is a rare fungal pathogen in breast augmentation/reconstruction surgery with only two prior cases of breast implant infections in the literature. Once as a disseminated infection in an immunocompromised patient following lung transplant2 and the other as a delayed subacute infection found on explanation in an immunocompetent patient3. This is the first recorded case of acute infection in the early postoperative period.

  1. Pyfer B, Chatterjee A, Chen L, et al. Early Postoperative Outcomes in Breast Conservation Surgery Versus Simple Mastectomy with Implant Reconstruction: A NSQIP Analysis of 11,645 Patients. Ann Surg Oncol. 2016;23(1):92-98. doi:10.1245/s10434-015-4770-2
  2. Sahi H, Avery RK, Minai OA, et al. Scedosporium apiospermum (Pseudoallescheria boydii) Infection in Lung Transplant Recipients. J Heart Lung Transplant. 2007;26(4):350-356. doi:10.1016/j.healun.2007.01.011
  3. Koan C, Venegas RJ, Murphy RA. A surprising complication of breast augmentation surgery. JPRAS Open. 2022;31:62-66. doi:10.1016/j.jpra.2021.10.010