What is the Best Treatment for Having Infection (Klebsiella Oxytoca) After Breast Augumentation? (photo)

I have had BA 4 Wks ago with severe pain after 2 Wks doctor in emerg decided to put needle in and drain fluid which was blood, the next day I had to rush back in very sick a ps came in and examined me and said we need to operate now! The ps removed implant cleaned out breast and drained fluid removed scar tissue and placed a drain and implant back! Put me on iv antibiotics 3 days now I'm on oral meds first gen meds, lab test confirmed bacteria.. Klebsiella oxytoca can bacteria survive on implant

Doctor Answers (6)

Infected Breast Implants

+1

The answer is yes, bacteria can and will survive on a breast implant surface.  I would have removed the implant and either drained the area or left it open.  But implant replacement, if it is truly infected is not what I would do.  I believe there is a risk of continued infection.

 


Dayton Plastic Surgeon
4.5 out of 5 stars 9 reviews

Infection and implants

+1

Usually with an infection the implant is removed and then the wound is often partially closed or left open to heal.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 15 reviews

Treating an infected breast implant

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The textbook answer to treat an infected breast implant is to remove it and leave it out for several months.  Your clinical situation isn't entirely clear from what you wrote so stick close to your plastic surgeon for care.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 47 reviews

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Infected implant should be removed.

+1

Infection after primary breast augmentation is extremely rare (I have had none in 26+ years of doing breast implants, though I have treated this problem from other doctors). When it does occur, symptoms such as yours ("very sick") indicate this is not just a "minor bacterial contamination" but rather a true systemic infection that started at your surgical site.

Klebsiella oxytoca is an unusual bacteria, more commonly seen in hospitals where there are other sick patients and more than a few nasty bacteria--did you have your original surgery in a hospital? What operation preceded yours?

Developing an infection may have been more due to the location of your surgery than anything related to your surgeon, scrub nurse, or operating /anesthesia team. But cultures confirm infection, and appropriate antibiotic therapy can be based on the basis of drug/organism sensitivity tests.

Certainly, no patient (and no plastic surgeon taking care of that patient, especially if called into the ER for another doctor's patient) wants to be left with an implant removed (especially if the other remains in), so there is ALWAYS an innate desire to "leave it in" and do everything else (antibiotics, even a drain) to try to somehow re-sterilize the implant and pocket. There are 2 problems with this that I see.

First, since an implant is non-living and has no blood vessels (to carry antibiotics or antibodies), it is a foreign object within your body and only your living tissues can eliminate bacteria. Yet there is still that "space" between your tissues and you implant where bacteria and bacterial biofilms can survive, never quite healing, and never completely going away, no matter how strong and how long the antibiotics.

Secondly, bacterial biofilm is the main cause of capsular contracture, so achieving a truly bacteria-free tissue pocket is necessary in order for you to have a normal soft (non-contaminated) breast. Almost impossible (if not completely impossible) to achieve that with a contaminated foreign body left in place, not to mention a drain!

In this setting, though we all hate the idea, the implant must be removed, the infection cured, the scar tissue allowed to soften and mature, and a new implant is inserted months later (timing up to the patient, surgeon, and your tissues, but 6-12 months is best).

Now you see why so many surgeons, when confronted by this truly unfortunate (despite being rare) situation, will try almost anything to leave the implant in and NOT do what usually needs to be done, which is the course of events described above, starting with removal of the infected or contaminated implant. Sure, it can be washed and even autoclaved (re-sterilized), but the tissues are still contaminated with bacteria, and replacing the implant into this environment immediately re-contaminates it!

The drain is a safety valve (and sometimes even an antiseptic irrigation pathway), and is a reasonable choice until you see your own surgeon and have your implant removed.

But to think (or imply) that this is a definitive treatment (implant left in, drain placed, and antibiotics) is equally foolish, since the drain also acts as a pathway for bacteria INTO your breast pocket, and would not be recommended in your initial surgery, and not now if this was not already considered an infected or bacteria-contaminated implant.

I wold recommend seeing your surgeon, who should remove your implant and treat your infection until resolved. Infectious disease consultation may be appropriate, but culture sensitivity-directed antibiotic therapy may well be sufficient (as long as the implant is removed).

If the implant is left in, I would anticipate things getting better (initially), drain being removed, and then a period of thinking things are OK right up until your breast starts to get sore, perhaps red, swollen, and you feel feverish or ill. Then more antibiotics, get better (or not, until stronger antibiotics are tried), then repeat this cycle until lots of time and money have been wasted and the implant finally is removed.

Even if you successfully avoid the above scenario, your risk of capsular contracture is significantly increased, and another (big, not always successful) operation may well be in your future.

Thus, I believe it behooves everyone to do the right thing now, and avoid the "trap" of wishful thinking that leads us down the path of incorrect decision-making. A bit strong of an opinion, but that is the scenario I have dealt with when other doctors' patients describe their difficulties until their infected implant is removed and the better path chosen. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 109 reviews

Infected implant after BAM

+1

You are sick from an infected implant.  This can get even more serious.  You need to get the implant removed ASAP.  There is debate over if the wound should be left open or closed, but since you are sick, I would leave it open and pack it.

After you are healed and healthy, usually at about 4 months, you can have a new implant placed.

I strongly disagree with the second implant placement.

Scott E. Kasden, MD
Dallas Plastic Surgeon
4.5 out of 5 stars 45 reviews

What is the Best Treatment for Having Infection (Klebsiella Oxytoca) After Breast Augumentation

+1

This is a very unusual organism to cause an implant infection--I can't find a case after a (brief) search. This organism is resistant to multiple antibiotics. I would insist upon being seen by an infectious disease specialist for evaluation. Do this through your surgeon or through your primary physician. 

Based on the incomplete info I have read here, I think it safest to remove the implant. Best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.5 out of 5 stars 30 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.