Post Reconstruction Breast Pyoderma Gangrenosum

Abstract

Summary:We report 3 cases of breast pyoderma gangrenosum in patients undergoing total mastectomy with immediate reconstruction. All three received systemic corticosteroid treatment, resulting in resolution of symptoms. As experience grew, early diagnosis in the third patient helped prosthesis salvage and timely return to the original course of reconstruction. This represents the first report of prosthesis salvage from post breast reconstruction pyoderma gangrenosum, and it demonstrates that implant removal is not always necessary during management of this rare condition.

Pyoderma Gangrenosum after Deep Inferior Epigastric Perforator Breast Reconstruction: Systematic Review and Case Report

“…PG has occurred in 6 DIEP, 5–10 8 TRAM, 11–18 and 2 LD 19,20 flaps used for breast reconstruction. The average patient age was 51 years (range: 30–73 y).…”

“…There have been multiple reports of postoperative PG after breast surgery with only 16 cases occurring after autologous breast reconstruction. PG has occurred in 6 DIEP, 5 – 10 8 TRAM, 11 – 18 and 2 LD 19 , 20 flaps used for breast reconstruction. The average patient age was 51 years (range: 30–73 y).…”

“…Most patients who underwent breast reconstruction using either TRAM or DIEP flaps developed abdominal donor-site wounds except for 2 cases (86%). 6 , 18 The 2 cases of reconstruction using LD flaps did not report donor-site wounds on the back. 19 , 20 There were 6 cases (38%) of bilateral breast reconstruction with 4 of these cases having developed bilateral breast wounds, 6 , 9 , 11 , 18 1 case with unilateral involvement, 8 and 1 case with unknown involvement.…”

“… 6 , 18 The 2 cases of reconstruction using LD flaps did not report donor-site wounds on the back. 19 , 20 There were 6 cases (38%) of bilateral breast reconstruction with 4 of these cases having developed bilateral breast wounds, 6 , 9 , 11 , 18 1 case with unilateral involvement, 8 and 1 case with unknown involvement. 15 Debridement was performed in 10 cases (63%) with only one of these cases undergoing a single debridement as the only secondary procedure.…”

“…The timely diagnosis and treatment of postsurgical PG in breast reconstruction patients is important to minimize poor aesthetic outcomes. A systematic review of the literature has shown the development of PG after 6 deep inferior epigastric perforator (DIEP), 5 – 10 8 transverse rectus abdominis myocutaneous (TRAM), 11 – 18 and 2 latissimus dorsi (LD) 19 , 20 flaps used for autologous breast reconstruction. We present a case of a patient with history of psoriasis and hidradenitis who underwent delayed bilateral DIEP flap breast reconstruction complicated by PG affecting the breast and abdomen.…”