Implant removed due to Pseudomonas and incision is now open again, what should I do? (Photos)

Question

I have a breast augmentation 5 weeks ago and my right breast had a hematoma that needed removed 8 days after BA. A week goes by and the incision opened and exposed the implant, my PS tried antibiotics and nothing worked for the result being pseudomonas. My right implant was removed 8 days ago and he loosely did the stitches to let it drain on its own but now I finished antibiotics and my Inc is open again and draining a little still. My PS office is closed. What should I do?

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs and I am sorry to hear of your implant and infection related issues.  At this point you need medical assistance and though his office is closed they should have a covering physician who can be of assistance.  Depending on what exactly is seen on the exam you need continued antibiotics and local wound care to allow your tissues time to heal from the inside out.  It may also benefit you to have a drain placed to help reduce the space created by the implant.  Best wishes on a speedy recovery.

Stefan Mark Szczerba, MD · Answer

Just allow that area to air dry!!  Don't try to convince your plastic surgeon close it!  Instead just let that area heal in by itself.  After completely healing over, your surgeon can cut out that scar and place another implant if you are still considering it.  Best Wishes!!

Jan Hochtritt, BSc, MD · Answer

Thank you very much for this question. I am sorry for your negative experience. Don't lose hope I am sure after your breast has healed a new implant will give you the look that you desire. Implants and their surrounding capsule can form an ideal host for certain pathogens.  That is why Implants should be removed when a breast is infected. Sometimes these pathogen's will persist in a so called biofilm on the remaining capsule that has formed around the implant. In those persistent infections  it is sometimes necessary to remove the capsule. Why are you not able to reach your plastic surgeon? Is it because it is weekend? You should consult a plastic surgeon preferably the one that has done the initial procedure. In spite of your misfortune have a wonderful rest of the day and greetings from the beautiful island of Jamaica

Fereydoon S. Mahjouri, MD · Answer

In addition to take the prescribed antibiotic for treatment of pseudomonas, I recommend putting silvadene cream or full strength Dakin's solution on the open wound and change it every 8 hours until you see your PS. It kills bacteria and wound will heal gradually from inside out.

Erez Sternberg, MD · Answer

This is a very unfortunate complication you are experiencing and I am so sorry to hear that. The risk of implant infection with cosmetic surgery is very low, when done in a specialized surgical facility that deals with infection control and proper sterilization, however, no one is completely immune from this often disasterous complication. That said, it is so important to know how to deal with the complication even though most cosmetic surgeons may only see this happen once in their career. We learn to deal with such disasters after 7 years of surgical training and ongoing continuing medical education. As states below, proper surgical management is vital now to ensure a satisfactory outcome. The wound needs to be opened, fully cleaned out to remove infected tissue and the capsule, and then drained while on antibiotics. A referral to an infection specialist is highly recommended. Once you are completely healed, the decision can be made to replace the implants (I wouldn't do this in less than one year). Good luck.

Darryl J. Blinski, MD · Answer

Seek Infectious Disease consultation. Most likely a pic line for daily IV antibiotics is needed. But best to try to coordinate via your PS office..>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Barry M. Schwartz, MD (retired) · Answer

Sorry about your complication. Now that the implant is out you should heal from the inside out, give local care till you heal. In approximately six months you can have the procedure done again.

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