Necrosis? Source of Infection?

I had asked about Strep g infection and implant removal.Thank you to all that replied. Here is my RB 7week post op.415cc Naturelle allergen (gummy bears)implants. I had them both removed 2 days after this photo. I was told I did NOT have necrosis. What do you think? How do you think I got this infection? Thank you

Doctor Answers 5

Infection and exposure of breast implant

Unfortunately, it rare to ever identify the ultimate source of most infections.  We all naturally have bacteria on our skin and this is often the source of many infections--especially Staph.  Before and during surgery we always strive to prevent infection by observing standard aseptic techniques and skin preparation.  Preoperative antibiotics can also decrease the risk of infection.   Certain medical conditions and the use of tobacco can also increase the risks for infection.  It is quite rare, however,  to have a Strep infection after augmentation and potentially very dangerous.  

The question of whether or not  necrosis was the source of the infection cannot be determined from the information that I have.  The question is whether the skin necrosis began before or after the infection.  Necrotic (or dead) skin can lead to infection, however a Strep infection can lead to necrotic tissue as well.  My guess (without know the sequence of events) is that the infection began first and this then led to necrosis of the skin.

Fortunately you are now doing fairly well considering the severity of the infection.  You can expect continued improvement of the scars and swelling.  Best wishes to you.

Charlotte Plastic Surgeon
4.7 out of 5 stars 28 reviews

This is an infected implant becoming exposed, not necrosis.

Necrosis means dead tissue. Your augmentation incision and breast pocket did not cause loss of circulation and ischemic skin necrosis. You developed an infection, which CAN cause tissue (breast or skin, or both) necrosis, leading to the wound opening up, and your implant becoming exposed. Without more information, it is impossible to state where the infection may have started.

Infection may have started with bacteria from the breast ducts, or the skin of the breast, or from the air, or from any number of potential contaminations that could have occurred. Antibiotics do not prevent infection; they just reduce the likelihood of the more common infections, and we now have more and more resistant bacteria in our everyday environment. You could have even gotten infected from contact with a pet (cats are worse than dogs), or from touching something that had a high(er) bacterial load and then touching your skin incision. Not blaming, but there are a huge number of possibilities for infection sources. Though this complication is rare, most of us have seen one or more cases in our careers just like yours. Equally sad and disappointing!

The important fact is that once infection starts, but has not yet advanced to the degree that it is evident, antibiotics can be tried (early when infection is not definite), but once it is a draining, open wound, then the contaminated implant must be removed, and the infection treated. If an effort is made to leave the implant in and "salvage" the impending disaster, the infection only worsens and fat necrosis can occur, so prompt removal is necessary. Your before-removal photos show implant exposure already, meaning your infection had dissolved enough tissue and suture material to allow the wound to open up and drain the infected pus. Things began to get better at this point (antibiotics or not), but now the implants are exposed to even more outside bacteria and must be removed. No salvage here other than to allow everything to heal, scar tissue to soften, and then start over.

Patients want this to be "right away," but surgeons are wise to delay for several months until the scar tissue softens as much as possible (the longer, the better), and your body's defenses and appropriate antibiotic therapy has COMPLETELY eradicated your infection. No sense getting reinfected with resistant residual bacteria, is there?

At this point, you should be patient and don't be over-anxious to replace your implants. Follow your surgeon's advice! Good luck and best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Breast Infection and Implant Loss

There is no way to tell the source of your infection which lead to your implant exposure and subsequent removal. I see no evidence of tissue necrosis.

Richard Linderman, MD
Indianapolis Plastic Surgeon
4.9 out of 5 stars 9 reviews

Necrosis? Source of Infection?

Thanks for the posted photos. You most likely had an implant infection that cause the wound to open. Removal was the correct course. There is no necrosis shown. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Breast Augmentation Disaster

I do not have your last posting and without getting more of a history it is impossible to tell you what caused your wound separation and implant exposure.

Necrosis is medical for dead tissue. This may be seen when the blood supply is interrupted.

From looking at your photographs I can tell you that your Breast Augmentation incision was extremely long and has separated. Such disasters can be caused by a severe infection inside the implant pocket making their way out, by exposure to smoking (which greatly decreases blood flow in the skin), in people with certain diseases or those taking medications which interfere with the immune process (such as corticosteroids).

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 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.