Breast Abscess After Autologous Fat Transfer

Volume 4, Issue 2, February – 2019 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Breast Abscess after Autologous Fat Transfer

1
Shadi Naasan Alhaj Ali, MD 2Ioan Lascar, MD, Ph.D.
1,2
Carol Davila University of Medicine and Pharmacy, Plastic and Reconstructive Microsurgery Department, Clinical Emergency
Hospital of Bucharest, Romania
Abstract:- Augmentation mammoplasty using complications such as excessive edema, excessive bruises,
autologous fat transfer has been widely practiced. hematoma formation, fat necrosis, infection and abscess
However, this procedure is not exempted from formation, calcifications, oil cysts, shape imbalance, and
complications even after technique refinements. These donor site complications.[3]
complications include excessive bruising, edema,
hematoma formation, infections, fat necrosis, oil cyst Infection and abscess formation are considered the most
formation, and donor site complications. The important complications because it may develop into severe
development of infection and abscess formation deserve septicemia and sepsis with high mortality, as well as the
the most attention. In case of delayed infection, a high infection process kills the grafted fat cells and the results
suspicion of unusual bacteria should be considered. will be disappointing. [3]
Case Presentation: We report the case of a 32-year-old
female patient underwent breast augmentation using In order to achieve successful fat grafting, and reduce
autologous fat graft; the patient demonstrated delayed the rate of complications, the technique used for fat
right sided breast abscess caused by a rare etiology harvesting, processing and insetting is the most important.
identified by culture as peptostreptococcus. This Gentle manipulation of the fat graft, good selection to the
anaerobic bacterium is commensal organisms in donor area, instruments selection and minimize graft
humans and under normal conditions does not cause exposure to the air or surroundings.
postoperative infection, and its pathogenicity is low.
The patient was treated properly and recovered fully II. CASE PRESENTATION
with no complications. Conclusion: Abscess formation
and infection development are not common A 32-years-old female patient underwent liposuction for
complications in the breast after fat transfer, but the abdomen and autologous fat transfer to the breasts 42
deserve attention and emergent management. As all days ago in another hospital.
grafts including fat graft are non-vascularized during
the first days postoperatively, these can be the host of The patient is single with no past medical illnesses and
unusual bacteria and cause severe infection. The sterile not a smoker. Her body mass index is 26 kg/m2 (length=158
technique should be considered at all time. In case of cm, weight= 65kg).
delayed infection, a high suspicion for anaerobic
peptostreptococci or other unusual bacteria should be The operation was done under general anesthesia with
considered. super-wet technique, about 800 ml of fat was harvested
from the abdomen, after unknown fat processing, 230 ml of
Keywords:- Fat Graft; Fat Transfer; Breast Abscess; the fat was transferred to the left breast, and 225 ml to the
Anaerobic Infection; Breast Lipofilling; right breast.
Peptostreptococcal.
The patient visited that hospital one week prior to
I. INTRODUCTION presentation to the emergency department with pain, edema,
and redness of the right breast accompanied by fever. She
Autologous fat transfer is one of commonest plastic said she had mild trauma on her right breast about 10 days
surgery procedures performed nowadays, due to the ago when she was opening the door and then the pain
development of liposuction techniques and the autologous started.
property of the fat as a typical biological soft tissue filler.
[1] She received antibiotic treatment with Augmentin
1000mg (amoxicillin and clavulanate potassium) orally
The American Association of Plastic Surgery (ASPS) twice daily, but she did not improve.
fat graft task force stated in 2009 that, 'Fat grafting may be
considered for breast augmentation and correction of At presentation, in the emergency department, she is
defects associated with medical conditions and previous dizzy, has pyrexia 38.5C, severe swelling, redness, and
breast surgeries, however, results are dependent on calor in her right breast. (Fig. 1).
technique and surgeon expertise’.[2]
Fat transfer can be employed to enhance the breasts'

shape, volume, or symmetry. Fat grafting to the breast as a
surgical procedure may accompany with some
IJISRT19FB50 www.ijisrt.com 143

ISSN No:-2456-2165
Interestingly, peptostreptococcus (an anaerobic

bacterium) was detected by culture after 5 days. and it was
sensitive to Vancomycin, which was continued for 10 days.
The general status of the patient improved at that time

and the blood laboratory test became normal levels of white
blood cells (8,100 cells/μL), and C-reactive protein (0.30
mg/dL).
III. DISCUSSION
Recently, the use of autologous fat graft as a soft

tissue filler is increasingly prevailing and practicing in
plastic surgery procedures due to its autologous nature,
availability in even thin women, easy to harvest,
Fig 1:- Preoperative photo findings, the right breast was inexpensive, and provide long term durability compared to
swollen with redness. the traditional fillers.[4]
Autologous fat grafting procedure goes through three

steps, fat harvesting, fat processing, and fat insetting.
Autologous fat transfer to the breast can be considered

for primary breast augmentation or for correction of breast
asymmetry caused by congenital deformities or past surgery
to the breast.[2]
Development of infection and abscess formation in

the breast after autologous fat transfer is not common but
deserve attention and emergent treatment.[3]
Generally, post-surgical infection and abscess

formation in the breast is caused by Staphylococcus aureus,
Fig 2:- Ultrasound of the right breast shows an ill-defined S. epidermidis, and S. pyogenes.[5]
complex cyst mass, linear specs are seen within the cyst,
generalized edema of the parenchymal tissue. These bacteria are known to be sensitive to
Vancomycin; which was started empirically.
Laboratory investigations revealed elevation in white
blood cells count (17,400 cells/μL) and C-reactive protein Interestingly, the bacterial culture revealed the
level (12.52 mg/dL). The other results were within normal presence of peptostreptococcus, which rarely causes
range. postoperative infection in normal patients because of its low
pathogenicity.
Ultrasound of the right breast demonstrated an ill-
defined complex cyst mass with heterogeneous internal Peptostreptococcus is commensal bacteria existing in
echoes, linear specs are seen within the cyst, which possibly the skin, mouth, gastrointestinal and urinary tracts, and
represents air, generalized edema of the parenchymal tissue vagina, as well as it considered as a component of the gut
around the cyst. (Fig. 2) flora. [6]
Emergency surgical treatment was performed under Peptostreptococcus is a gram-positive anaerobic

general anesthesia, the abscess was incised and drained bacterium and non-spore forming.[7]
using periareolar approach, about 300 ml of pus was
drained which was a mixture of melted fat tissue and liquid Under special conditions, such as immunosuppression
discharges, yellow in color with no bad odor. or trauma with necrotic tissues, these bacteria can become
pathogenic, causing infection and systemic sepsis.
All drained necrotic tissue and pus were sent to
pathologic analysis. Peptostreptococcus can be the cause of lung abscess,
liver abscess, breast abscess, and necrotizing fasciitis, also
Empirically, gram-positive bacteria was suspected as it can participate in mixed anaerobic infections.[8]
the cause of infection, so intravenously Vancomycin
(2000mg/day) was started immediately while waiting for
the results of culture and sensitivity.

ISSN No:-2456-2165
Peptostreptococcus species are sensitive to several ACKNOWLEDGMENT
antibiotics including beta-lactam. [9]
The authors declare that all the procedures of this case
The diagnosis of a peptostreptococcus infection starts respect the ethical standards in the Helsinki Declaration of
with a thorough clinical assessment. A detailed patient 1975, as revised in 2008, as well as the national law.
history, during which the physician must assess the
presence of symptoms, their course, and progression, is The authors declare that no conflict of interest
highly important. regarding the article. Informed consent was obtained from
the patient in this case.
Once sufficient evidence is obtained and a
presumptive diagnosis of an infection is made, No funding for this report.
microbiological testing is the cornerstone for identifying the
underlying cause. REFERENCES
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[2]. K. A. Gutowski. Current applications and safety of
Aspirates, tissue specimens, or blood samples are autologous fat grafts: a report of the ASPS fat graft
much better samples for the preservation of task force. Plast. Reconstr. Surg 2009;124(1):272–
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microbiological identification. [10] [3]. Valdatta L, Thione A, Buoro M, et al. A case of life-
threatening sepsis after breast augmentation by fat
Despite the fact that peptostreptococci are injection. Aesthetic Plast Surg 2001;25:347-9.
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must not be overlooked when other sites are involved in the Guerrerosantos J, Valenzuela L, Espejo I, Robles JA,
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[10]. Riesbeck K, Sanzén L. Destructive Knee
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[11]. Riggio MP, Lennon A. Identification of Oral
Once even low pathogenic bacteria contaminate the Peptostreptococcus Isolates by PCR-Restriction
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Volume 4, Issue 2, February – 2019 International Journal of Innovative Science and Research Technology

Breast Abscess after Autologous Fat Transfer

Fat transfer can be employed to enhance the breasts'

IJISRT19FB50 www.ijisrt.com 143

Interestingly, peptostreptococcus (an anaerobic

The general status of the patient improved at that time

Recently, the use of autologous fat graft as a soft

Autologous fat grafting procedure goes through three

Autologous fat transfer to the breast can be considered

Development of infection and abscess formation in

Generally, post-surgical infection and abscess

Emergency surgical treatment was performed under Peptostreptococcus is a gram-positive anaerobic

IJISRT19FB50 www.ijisrt.com 144

IJISRT19FB50 www.ijisrt.com 145

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