Transaxillary Capsulorrhaphy with Reimplantation to Correct Bottoming-Out Deformity in Breast Mycobacterial Periprosthetic Infection: A Case Report with Literature Review

Abstract

Augmentation mammoplasty is one of the most popular cosmetic surgeries, but there is a high reoperation rate (29.7%) commonly due to capsular contracture, implant malpositioning, infection, and unsatisfactory size. Although infection only accounts for 2% of cases, its management is very challenging, especially with nontuberculous mycobacteria (NTM) infection. Breast prosthetic NTM infection is a rare but is a disastrous condition with an incidence of approximately 0.013%. Immediate salvage reimplantation is usually not suggested, and most studies recommend a gap of 3 to 6 months after combination antibiotics therapy before reimplantation. However, delayed reimplantation often leads to great psychological stress and struggle between the doctor and patient. We present the case report of successful reimplantation in treating prosthetic NTM infections in a 28-year-old female. We discuss a novel technique “transaxillary capsulorrhaphy” to correct the bottoming-out deformity. One year after the combination of antibiotics and surgery, the follow-up computed tomography scan showed complete remission of NTM without recurrence. We discuss the surgical technique in detail. The 1-year follow-up assessment (photos and dynamic video) revealed good cosmesis and reliable correction using the new technique. This report is the first formal description and discussion of one-stage reimplantation following NTM infections. Transaxillary capsulorrhaphy allows for a successful salvage operation when an implant is displaced. This approach provides highly favorable result in eastern women undergoing revision augmentation mammoplasty. This study reflects level of evidence V, considering opinions of respected authorities based on clinical experience, descriptive studies, or reports of expert committees.

Keywords

bottoming-out deformity - capsular flap - transaxillary capsulorrhaphy - mycobacterial infection

Authors' Contributions

T.C.H.: conceived and designed the analysis, collected the data, contributed data or analysis tools, performed the analysis, prepared the manuscript, treated this patient in major and perform the surgical procedure for revisional mammoplasty, and followed-up and record all the result in major.

J.J.L.: supervised and revised the article.

K.-H.Y.: contribute the idea of transaxilla bra-flap technique in bottoming out deformity correction and supervised and revised the article.

C.C.: consultation for the antibiotics treatment in nontuberculosis mycobacteria infection and revised and describe of antibiotics treatment for this patient.

Y.C.C.: draw Fig. 3 to demonstrate the idea of transaxilla bra-flap technique.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors. It doesn't require Ethical Approval.

Patient Consent

The patient has signed the informed consent for the publication of photos and videos.

Publication History

Received: 27 January 2023

Accepted: 21 June 2023

Accepted Manuscript online:
28 June 2023

Article published online:
01 December 2023

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