Right breast infection. Should I go with an areola incision next time?

Question

Right breast got infected after breast augmentation. It was to late to save the implant. This is the second time this has happen. Both times it had E Coli. on the wound. I was told I have to wait another 6 months to get another implant in. This time i was thinking of going in through the Areola instead of the under the boob incision. Going to get 2 second opinion from a different Plastic surgeon. Let me know what you guys think. Thanks

Gerald Minniti, MD, FACS · Answer

Although you've been unlucky twice, don't blame the inframammary incision, which is the safest incision precisely because you are less apt to get implant contamination. Unfortunately, I would place blame on your surgeon or the surgery center, something I'm loathe to do. E. coli is not skin flora, it is from our gut, and may indicate either sterility problems in the OR or contamination after surgery at home. Implant infection is very rare in primary breast augmentation, and although it's more common in revision, it's still kind of like lightning striking twice. Yes for new doc (and new surgery center), no for new incision.

Ronald J. Edelson, MD · Answer

I would be interested in what was done between the first two operations. How long did you wait before having the implants placed again. A few months would not have been enough time

Connie Hiers, MD, FACS · Answer

Photos would be helpful, but the areolar incision has a higher risk of infection than the underneath incision.  Unless the beast tissue is thin in that area, I would suggest the same incision. E coli is bacteria that you are probably picking up in the bathroom. You need to wash your hands very well each time before you leave the bathroom and clean that room very well prior to surgery.

Alex Cheah, MD · Answer

Hey there - generally an areolar approach is less favorable because it exposes the implant directly to the breast tissue and has shown higher rates of infection. However, in your case, it may not matter which incision is used since you have shown a tendency to have repeat E coli infections, which are uncommon for breast surgery in general. This could mean either your skin or the breast pocket are colonized. It would be worth talking to your plastic surgeons about how to manage the potential for bacterial colonization regardless of which incisions is used. Hope that helps!

Right breast infection. Should I go with an areola incision next time?

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