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Dr. Linder's Blog


Posted On: July 20, 2009 Author: The Office of Dr. Stuart Linder Posted In: Breast Revision


A case was presented to me a couple of days ago as an acute emergency.  Description of the case includes a patient who underwent silicone gel augmentation approximately 20 years ago in the submuscular pocket.  She had dental work approximately three months ago and has had increasing swelling and tenderness to her bilateral breasts.  She was referred by an infectious disease specialist to Dr. Linder for evaluation and reconstruction.  Upon seeing the patient in consultation, it was obvious that she had some form of an infection, though no specific organism had been determined.  The patient showed a three-month history of myalgia, fatigue, intermittent fevers, and swelling (right breast greater than the left).  This occurred three months after dental work and a mandibular abscess debridement with a root canal.  The patient was set up for surgery in the hospital at which time the surgical consent included bilateral exploration of chest, explantation of silicone implant and implant material, open capsulectomy, bilateral cultures and sensitivities (aerobic, anaerobic and fungal nature), irrigation and drain placement bilaterally.  The implants could not be replaced for several months until the patient is completely cleaned and has been cleared by an infectious disease specialist.

Surgery took place and she did extraordinarily well.  Of interest, the tissue appeared to be quite slimy and grungy which appeared to be possibly a staphylococcus, epidermis or aureus type of infection, though cultures are pending.

The point of this interesting case is I believe patients who undergo dental work or who have breast implants should undergo prophylactic antibiotics.  The amount of time or duration of the antibiotics is variable and there is no specific standard.  However, I believe 24 hours before and up to 24 hours after would be reasonable in my patient population to have prophylactic and continued oral biotics to prevent staphylococcus infections.