Abstract
Reduction mammaplasty is one of the most common surgeries performed by plastic surgeons. It relieves back and neck pain and improves the aesthetic contour of the ptotic breast. Postsurgical pyoderma gangrenosum (PSPG) is an unusual inflammatory disorder leading to rapidly progressive skin necrosis that can occur after any surgical procedure. The skin lesions have the characteristic appearance of ulcers with a purple-colored border and erythematous halo. Clinically, the patient has a low fever and severe local pain. In the majority of cases this disease is misdiagnosed as severe infection leading to improper debridement, exacerbating the problem. The mainstay of therapy for PSPG is still nonoperative and focuses on immunosuppressive medications and local wound care, which allows healing in the majority of the cases. It is important for plastic surgeons and infectologists to be cognizant of this entity, as a delay in diagnosis and management can be life-threatening and lead to considerable tissue loss and disfigurement of the breast. The authors report a case of reduction mammaplasty complicated with PSPG and its treatment.
Level of Evidence V
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References
Clugston PA, Thompson RP, Schlappner OL (1991) Pyoderma gangrenosum after reduction mammoplasty. Can J Surg 34(2):157–161
Brunsting LA, Goeckerman HW, O’Leary PO (1930) Pyoderma (Echtyma) gangrenosum. Clinical and experimental observations in five cases occurring in adults. Arch Dermatol Syphilol 22:665–680
Simon AM, Kuthaila D, Hammond D, Andrés A (2006) Pyoderma gangrenosum following reduction mammaplasty. Can J Plast Surg 14(1):37–40
Poncke SV, Jorens PG, Peetrs R, Jacobs W, De Beeck BO, Lambert J, Beaucourt L (2004) Pyoderma gangrenosum: a challenging complication of bilateral mastopexy. Int Wound J 1:207–213
Furtado JG, Furtado GB (2010) Pyoderma gangrenosum in mammaplasty and abdominoplasty. Rev Soc Bras Cirg Plast 25(4):725–727
Berry MG, Tavakkolizadeh, Sommerland MB (2003) Necrotizing ulceration after breast reduction. J R Soc Med 96:186–187
Gulyas K, Kimble FW (2003) Atypical pyoderma gangrenosum after breast reduction. Aesthetic Plast Surg 27:328–331
Apalla Z, Lallas A, Karteridou A, Sotirion E, Papairannou K, Chaidemenos G (2012) Letter: pyoderma gangrenosusm complicating mammaplasty. Int Wound J. doi:10.111/j.1742-481.x.2011.00916.x
Reddy R, Favrean T, Stokes T, Skopit S (2011) Pyoderma gangrenosum following breast reconstructive surgery: a case report of treatment with immunosuppression and adjunctive xenogeneic matrix scaffolds. J Drug Dermatol 10:545–547
Goshtasby PH, Chani RG, Johnson RH (2010) A novel approach to the management of pyoderma gangrenosum complicating reduction mammaplasty. Aesthet Surg J 30:186–193
Schintler MV, Grohmann M, Donia C, Aberer E, Schartnagl E (2010) Management of an unfortunate triad after breast reconstruction: pyoderma gangrenosum, full thickness chest wall defect and Acinetobacter baumannii infection. J Plast Reconstr Aesthet Surg 63:564–567
Schoeman MB, Zenn MR (2010) Pyoderma gangrenosum following free transverse rectus abdominis myocutaneous breast reconstruction: a case report. Ann Plast Surg 64:151–154
Rietjens M, Cuccia G, Brenelli F, Manconi A, Martella S, De Lorenzi F (2010) A pyoderma gangrenosum following breast reconstruction; a rare cause of skin necrosis. Breast J 16(2):200–202
Rajapakse Y, Briker CB, Ghattoura A, Jallali N, Henton J, James SE, Harris PA, Searle AE (2010) Case report: pyoderma gangrenosum following deep inferior perforator (DIEP) free flap breast reconstruction. J Plast Reconstr Aesthet Surg 63:395–396
Bonamigo RR, Behar RR, Beller G, Bonfá R (2008) Pyoderma gangrenosum after silicone prosthesis implant in the breasts and facial plastic surgery. Int J Dermatol 47:289–291
Ouazzani A, Berthe JV, De Fontaine S (2007) Post-surgical pyoderma gangrenosum: a clinical entity. Acta Chir Belg 107:424–428
Davis MD, Alexander JL, Prawer SE (2006) Pyoderma gangrenosum of the breasts precipitated by breast surgery. J Am Acad Dermatol 55:317–320
Gonçalves J, Capon Degardin N, Laurent F, Batard ML, Pellerin P (2002) Familial pyoderma gangrenosum following a mammoplasty reduction: a case report. Ann Chir Plast Esthet 47:308–310
Lifchez SD, Larson DL (2002) Pyoderma gangrenosum after reduction mammaplasty in an otherwise healthy patient. Ann Plast Surg 49:410–413
Mackenzi D, Moimen N, Frame JD (2000) Pyoderma gangrenosum following breast reconstruction. Br J Plast Surg 53:441–443
Gudi VS, Julian C, Bowers PW (2000) Pyoderma gangrenosum complicating bilateral mammaplasty. Br J Plast Surg 53:440–441
Sotillo-Gago I, Muñoz-Pérez MA, Camacho-Martinez F (1999) Pyoderma gangrenosum after augmentation mammoplasty. Acta Derm Venereol 79(6):486
Gran Salvat C, Miguel FJ, Pont V, Aliaga A (1998) Pyoderma gangrenosum: unusual complication following mammoplasty reduction. Int J Dermatol 37:794–796
Duval A, Boissel N, Servant JM, Santini C, Petit A, Vignon-Pennamen (2011) Pyoderma gangrenosum of the breast: a diagnosis not to be missed. J Plast Reconstr Aesthet Surg 64:17–20
Mansur AT, Balaban D, Goktay F, Takmaz S (2010) Pyoderma gangrenosum on the breast: a case presentation and review of the published work. J Dermatol 37:107–110
Lear JT, Ateron MT, Byrne JPH (1997) Neutrophilic dermatoses: Pyoderma gangrenosum and Sweet’s syndrome. Postgrad Med J 73(856):65–68
Su WPD, Davis MD, Weenig RH et al (2004) Pyoderma gangrenosum: clinicopathologic correlation and proposed diagnostic criteria. Int J Dermatol 43:790–800
Tay YK, Friednash M, Aeling JL (1998) Acute pyoderma gangrenosum does not require surgical therapy. Arch Fam Med 7(4):377–380
Schofer H, Baur S (2002) Successful treatment of postoperative pyoderma gangrenosum with cyclosporin. J Eur Acad Dermatol Venereol 16(2):148–151
Rozen SM, Nahabedian MY, Manson PN (2001) Management strategies for pyoderma gangrenosum treatment. Case studies and review of the literature. Ann Plast Surg 47(3):310–315
Davis JC, Landeen JM, Levine RA (1987) Pyoderma gangrenosum: skin grafting after preparation with hyperbaric oxygen. Plast Reconstr Surg 79(2):200–207
Echo A, Guerra G, Yuksel E (2010) The dermal suspension sling: shaping the inferior pedicle during breast reduction. Aesthetic Plast Surg 35:608–616
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Grillo, M.A., Cavalheiro, T.T., da Silva Mulazani, M. et al. Postsurgical Pyoderma Gangrenosum Complicating Reduction Mammaplasty. Aesth Plast Surg 36, 1347–1352 (2012). https://doi.org/10.1007/s00266-012-9981-3
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DOI: https://doi.org/10.1007/s00266-012-9981-3