Beware of Pyoderma Gangrenosum Complicating Mastopexy: The Importance of Early Detection and Treatment

Cosmetic breast procedures are widely performed by plastic surgeons all over the world with high satisfaction rate for patients. The most common complications described for reduction mammaplasty and mastopexy are wound dehiscence, breast asymmetry, partial or total loss of the nipple-areolar complex (NAC). Pyoderma gangrenosum (PG) is a rare ulcerative dermatitis of unclear origins first described in 1930. In most of the cases, it is associated with autoimmune systemic conditions such as Inflammatory Bowel Diseases and several rheumatologic diseases. PG has been reported to occur predominately in lower limbs but any other area of the body can be affected [1,2]. A 50-year-old patient presented to my outpatient clinic seeking mastopexy. She was healthy, non-smoker and reported no history of systemic diseases. After routine consultation, she was scheduled for surgery two weeks later. Surgical plan included autoaugmentation mastopexy using Ribeiro’s pedicle and a superomedial pedicle for the NAC (Fig. 1). No breast tissue was discarded during the procedure. Immediate postoperative course was uneventful and patient was discharged the day after the operation. At 10 day follow-up small ulcerations mimicking a suture reaction were observed along the vertical scar of the right breast and at the level of the left nipple. Conservative treatment was adopted, with general antibiotic ointment and frequent dressing changes. No improvements were noted in the following days: ulcers became larger and painful, increasing patient's discomfort. Sporadic cases of PG complicating breast procedures have been reported. PG often arises following any trauma, leading to a pathergic phenomenon with catastrophic non-healing wound complications which can cause distress for both the patient and the surgeon [3]. On postoperative day 20, expanding ulcers with purulent-like appearance involving both breasts, resembling wound dehiscence on the right side were noted. PG was suspected and patient scheduled for surgical revision (Fig. 2). Moreover, to exclude any systemic illness associated with PG, patient underwent colonoscopy and serology testing for Beware of Pyoderma Gangrenosum Complicating Mastopexy: The Importance of Early Detection and Treatment