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Acellular dermal matrix (ADM) is an increasingly popular alloplastic cadaveric dermis used to enhance postmastectomy reconstruction. Acellular dermal matrix can be used as a nipple-shaped cylinder in central pillar nipple reconstruction to help maintain long-term projection. We report a unique presentation of ADM mimicking a retroareolar mass after central pillar neonipple reconstruction. A 49-year-old woman with a history of invasive ductal carcinoma underwent delayed nipple reconstruction after lumpectomy and oncoplastic closure using an inframammary V-Y advancement flap.The nipple reconstruction was performed using pretattoo and articulated tab flaps. A rolled tube of acellular dermal matrix was placed in the central aspect of the neonipple reconstruction for projection. At 4 months postoperative, a screening mammogram and ultrasound noted a new retroareolar mass classified as BIRADS 4 necessitating a breast biopsy. Biopsy revealed portions of fibrous connective tissue consistent with partially incorporated acellular dermal matrix allograft. There was no evidence of malignancy. To mitigate the risk of future radiographic or clinical misinterpretation of ADM in nipple reconstruction, the placement of radiopaque markers such as microclips on the ADM implant could be a useful adjunct. Radiologists and surgeons should include ADM artifact in their differential diagnosis of radiologic imaging when evaluating a new mass in the proximity of prior ADM placement in neonipple reconstruction of the breast.

Up to 17.6% of COVID-19 positive patients present with gastrointestinal symptoms and bowel wall abnormalities have been described in up to 31% of COVID-19 positive patients. Here, we present a case of a 40-year-old male diagnosed with COVID-19 complicated by hemorrhagic colitis leading to colonic perforation. CT scan of abdomen and pelvis demonstrated markedly distended descending and sigmoid colon with poorly defined wall, pneumatosis, and pneumoperitoneum. The patient was taken for emergent exploratory laparotomy for extended left hemicolectomy, partial omentectomy, transverse colostomy creation, abdominal washout, repair of small bowel, and appendectomy. The patient was brought back for repeat exploratory laparotomy with ICG perfusion assessment. Patient was found to be heterozygous for factor V Leiden mutation and was never vaccinated for COVID-19. Our case demonstrates a novel use for indocyanine green (ICG) to assess perfusion and underscores the importance of completing a thorough hypercoagulable evaluation following COVID-19 induced thrombotic event.