Breast Necrosis Following Coronary Artery Bypass Grafting

Abstract

We present a case of left breast necrosis following coronary artery bypass grafting which was misdiagnosed as a breast cancer. Breast necrosis after myocardial revascularization is an extremely rare complication of the surgical procedure using the most conventional graft which is the left internal mammary artery. The left internal mammary artery is the main blood supplying artery of the left breast.

Focal necrosis mimicking breast cancer following coronary bypass grafting

“…There was no need for any further plastic surgical reconstructions, as opposed to the works of and Rashid et al and Morris et al [5, 13] (post-mastectomy skin-graft), or Harish et al [11] (vertical rectus abdominis myocutaneous flap). Post-mastectomy healing is undoubtedly influenced by the extent of necrosis—if necrotic tissue is completely included in the resected mass, healing by first intention may be expected, as what occurred in our case and some other published works [7, 10]. …”

“…Most of the patients suffered from chronic renal insufficiency, often with the need of hemodialysis, sometimes accompanied by calciphylaxis, which is the systemic medial calcification of small and medium blood vessels of the skin, leading to tissue ischemia and painful skin ulcerations [5]. In the case report of Bintoudi et al, the authors demonstrate extensive vascular calcifications on the mammogram [10], and Rashid et al even suggest using mammography for evaluation of the rates of vascular insufficiency [5]. In other case reports, neither renal insufficiency nor calcifications are mentioned; the authors are thinking of different possible dominant risk factors, namely a macromastia, since all patients were women, mostly with large breasts.…”

“…Given the non-specific symptoms, our patient was diagnosed with ischemic necrosis as late as 14 weeks (3 months) after the revascularization procedure. Such a mimicking of mammary carcinoma has been described in only two case reports where a biopsy had to be used for a differential diagnosis [5, 10]. …”

“…As for the treatment, debridement, antibiotic therapy, and healing by conservative ways through granulation were sufficient in the two of the so far described cases [4, 8]. In other cases, the condition was handled by more extensive resections, through partial or total mastectomy [5, 7, 10, 11, 13], sometimes with resection of thoracic or abdominal walls [5, 7, 10]. Subsequent surgical reconstructions with skin grafts or more complex fasciocutaneous or musculocutaneous flaps occasionally had to be used [5, 6, 9, 11].…”

Breast Necrosis Following Coronary by Pass Graft Surgery: Report of Two Cases & Review of Literature

“…Fat necrosis and chest wall necrosis are reported entities related to breast trauma, severe infections or chest wall irradiation [1]. However, total breast necrosis is of remote occurrence.…”