Fistulogram for Breast with Implant?

asked 3 years ago by imnyc in New York
Latest answer by Steven Wallach, MD
Question viewed 914 times
Tags: sinus

What do you think of Fistulogram for an augmented breast? To give you a little background, I have a hole under the breast / right in the crease area that would not heal (my incision is via areola) I am concerned about the danger of having iodine injected in my breast with the implant there. What are the risks of a Fistulogram? And alternatives or other methods to diagnose the problem? My breast is already inflamed with all things going on (although the fluid had been cultured and it showed no growth)... my surgeon and myself had tried to manually 'collapse' what he thinks is a cavity but have no success... Thank you in advance for your response.

11 answers to Fistulogram for Breast with Implant?

Fistulogram and Breast Implants

Thanks for the question. You describe a bit of an unusual problem. It is strange to have a fistula as you describe that is not connected with the original incision. Typically, infections or healing problems manifest themselves at the weakest point, which in the immediate post-op period is at the original incision - your areola. Previous incisions or radiation can change this somewhat. If you've had the implants for a while and developed a new draining wound in the breast crease, this... more

Steven H. Williams, MD
San Francisco Plastic Surgeon

Your implant may very well be infected

The situation you are describing may very well represent a chronic low grade infection of your implant, which in the majority of cases will not heal without removal of the implant and replacement at a later date (usually at least 6 months later). While this sounds like a very undesirable option, it may be the only way to clear the infection. You should also know that even if the small hole is made to heal over time and and with antibiotics, it doesn't mean that that breast will look... more

Shahram Salemy, MD
Seattle Plastic Surgeon

The key is to determine if the implant cavity conncts to the outside world

If the opening in your crease connects into the implant pocket, the implant technically is considered infected and most likely will need to be removed and replaced later. Rarely can this kind of situation be salvaged without implant removal. What your doctor is trying to do is determine if the connection exists, because if it does, that would explain why it has not healed. A fistulogram is not dangerous and water soluble contrast material can be used. What you have is not normal and... more

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

OK to Try

Injecting a type of dye into this hole should give information if the hole is communicating with the implant pocket, or there is a separate sinus cavity. It sounds as if you have a "subclinical" infection that caused the implant to extrude along the fold. If this communicates with the implant, it must be remived and the area allowed to heal for several months before reinserting it. If there is a separate process, it too must be excised ans/or drained..

Michael S. Beckenstein, MD
Birmingham Plastic Surgeon

Fistulogram after breast augmentation

It sounds like you have a chronic low grade infection with organisms which may be difficult to culture. In my opinion, the prosthesis should be removed, the fistula excised and the pocket sterilized, with reimplantation at a later date. A fistulogram with iodine contrast would be of no value and might be contraindicated for several reasons.

Barry H. Dolich, MD
Bronx Plastic Surgeon

You likely need to have your implant removed temporarily

IMNYC, It sound like you have a very unusual situation. Has the hole been there since your surgery. Has your breast always been inflamed since the surgery? If there is an infection, which it sounds like there is, then you need both surgery to remove the implant and antibiotics to help clear the infection. Once you are all healed in say 6 to 12 months, then you could possibly have the implant replaced. If the implant cavity is infection, treating just with antibiotics is not going to... more

David Shafer, MD
New York Plastic Surgeon

Prepare to lose the implant

I would say that the fistula won't likely hurt anything. However it seems most likely that you have an infection around the implant that is draining from the hole beneath the breast. Under sterile conditions, the doctor can explore the fistula with a sterile Q-tip, and get an answer. With the imflammation, and the chronicity, you will likely need the implant removed. Even if you were to avioid removal, the implant will likely get a severe contracture and require even more surgical... more

Scott E. Kasden, MD
Dallas Plastic Surgeon

The implant will probably have to be removed.

I don't think a "fistulogram" will hurt you, but may not help. I don't understand why there is a "hole" under your breast if the incision was in the areola? But just from your description, the likely outcomes are wound not healing, or implant becoming hard. So you may need to have the implant removed and re inserted in 6 months. Complications just happen. What matters is the final result.

George J. Beraka, MD
Manhattan Plastic Surgeon

Have the fistulogram and hopefully no connection is found

This is an unsual situation, but it seems like a low grade infection preventing the wound from healing. If there is a connection to the implant cavity (which will be confirmed by the fistulogram) there is a high chance that the implant will be removed. It is better to take things step by step and not to jump to conclusions. I would follow your doctor recommendation to get more info. Hope that helps!

Hisham Seify, MD, PhD
Los Angeles Plastic Surgeon

Fistulogram in chronic breast wound

I doubt you need the fistulogram. I would think that the wound is a chronic draining sinus from a chronic infection or foreign body reaction to perhaps the implant or sutures.

Steven Wallach, MD
Manhattan Plastic Surgeon

Never heard of fistulogram for this case

IM, Your story is very interesting. I have personally never heard of getting a fistulogram for a draining sinus in a breast that has an implant. After reading your additional comment, I have a somewhat better understanding of your history. However, it still doesn't explain the need for a fistulogram. If you and your surgeon have been manually squeezing your breast to collapse a cavity, and are getting drainage when you manipulate the breast, and the whole breast is swollen, then it... more