Nontuberculosis Mycobacteria Infection After Liposuction and Fat Grafting for Augmentation Mammoplasty

Abstract

BackgroundNontuberculosis mycobacteria (NTM) commonly occur in nature. Although the infection rate is low, soft tissue infection with NTM after surgical procedures is possible in both immunocompromised and normal populations. For cosmetic surgery, NTM infection has emerged as a common infection in the recent years, and this indicates the need to pay more attention, especially to those with prolonged atypical uncertain wound problems.Aim and ObjectivesWe aimed to report a case of NTM infection after breast augmentation to share our experience on clinical appearance and process of diagnosis and treatment, and to review the existing literature.Materials and MethodsWe retrospectively review a patient who suffered from NTM infection after liposuction and fat grafting for breast augmentation between 2019 and 2021 in our hospital. The baseline characteristics, operations, bacterial culture report, medications, and outpatient information were collected from medical records.ResultsThe patient suffered from purulent skin lesions after breast augmentation and was diagnosed with NTM infection according to the culture report. The NTM infection was resolved after a long-term course of treatment for around a year, including surgical debridement, serial aspirations, and prescriptions of antituberculosis medications.ConclusionsThe results of our study suggest that NTM must be considered when facing refractory infections after surgeries or invasive procedures without bacterial growth on routine cultures. Acid-fast stain and mycobacterial culture are strongly recommended. Treatment modalities include localized aspiration, surgical debridement, and multidrug antibiotics based on the sensitivity of the microorganism.

Postoperative infection mycobacterium abscessus associated with liposuction and autologous fat grafting: A narrative review

“…Azithromycin could cause leukopenia whereas cefoxitin might result in maculopapular rash and leukopenia. Besides, clofazimine might be a cause of hyperpigmentation [10,20,24,27,36,40,41]. Some complicated M. abscessusinfected cases requiring special treatment or longer treatment time were reported [10,36,40,42].…”

“…Histopathologic images showed ulcerous or granular lesions [23,34,37,38]. Meanwhile, fluid collection, abscesses, and air foci were seen in CT scans [10,21,26,[39][40][41].…”

“…Yang et al reported that it demanded 3 times culture to obtain a positive result of M. abscessus [20]. Additionally, the time to diagnosis of M. abscessus from the first visit due to M. abscessus infection after liposuction/autologous fat grafting was 6 -70 days [20,21,25,26,41,[45][46][47]. It often took about 2 -4 months from the first symptom to diagnosis.…”

“…Most antibiotic regimens included 1 -2 drugs [10,20,23,24,26,27,34,36,38,39,41,42,44,4 5]. Even though, some authors preferred to use 3 drugs and above [37,41,42,47]. These empiric antibiotic regimens were poorly effective, resulting in antibiotic changes when M. abscessus had still not been confirmed [27,41].…”

“…Even though, some authors preferred to use 3 drugs and above [37,41,42,47]. These empiric antibiotic regimens were poorly effective, resulting in antibiotic changes when M. abscessus had still not been confirmed [27,41]. Sometimes, antifungal medicine such as fluconazole was added to the regimen [37].…”