Peptococcus Infection after Breast Augmentation Using Autologous Fat Injection

669 IMAGES injection to correct defects in the upper and inner portion of both breasts using fat obtained through liposuction, 40 days before presentation at our hospital. Her initial surgery was performed in an aesthetic plastic surgery clinic, and the amount of fat extracted and transplanted was not precisely known. Ten days before presentation at our hospital, the patient visited the clinic with a slight fever accompanied by edema, pain, and calor in the left breast. She received antibiotic treatment with ceftriaxone (CJ CheilJedang Corp., Icheon, Korea) and metronidazole (Kunhwa Corp., Gongju, Korea), but did not improve. At presentation, the swelling and calor in her left breast had worsened and both breasts had severe edema (Fig. 1). Blood tests showed an elevated C-reactive protein (CRP) level of 8.43 mg/dL, erythrocyte sedimentation rate (ESR) at 120 mm/hr, and white blood cell (WBC) count at 18,800 cells/μL. Emergency surgery was performed using a periareolar incision, and the abscess was drained. As the incisions were made, necrotic and melted fat that was seen as a clear, greasy, liquid discharge, which was followed by a yellowish discharge and finally a sticky, foamy discharge emerged. All were drained and removed together along with the necrotic tissue. The abscess in the left breast was drained of 120 mL of liquid, and 70 mL out of the right breast (Fig. 2). No foul odor was noted. The necrotic tissue and drained abscess contents were analyzed for the presence of gram-positive bacteria, gram-negative bacteria, anaerobic bacteria, and mycobacteria. An infection caused by gram-positive bacteria was assumed, and empiric vancomycin (2 g/day, CJ CheilJedang Corp.) was administered while waiting Peptococcus Infection after Breast Augmentation Using Autologous Fat Injection