Breast Implant Mycobacterial Infections – An Epidemiological Review and Outcome Analysis

Background: Epidemiological evidence of periprosthetic mycobacterial infections (PMIs) is limited. The recent boom in cosmetic surgery tourism has been associated with a rise of surgical site infections (SSIs) in returning patients. This review aims to explore available data, examine trends of documented PMIs and analyze outcomes of management techniques. Methods: A search in Biosis, Embase, LILACS, Medline, and Web of Science databases from inception until December 2017 for "Breast Implants" and "Mycobacterial Infections" and equivalents was performed. Data were pooled after two screening rounds following full-text retrieval and cross-referencing. Results: Forty-one reports describing 171 female patients who had breast prosthesis-related mycobacterial infections were identified. Bibliometric case-based analysis revealed a rise of PMIs in developing countries since the start of the millennia. The mean age was 37.9 years and the majority of cases followed bilateral breast augmentation. Most patients presented with breast pain or tenderness, after an average incubation period of nine months. M. fortuitum was isolated from 90 (52.6%) of cases. Immediate explantation, with or without delayed re-implantation was most commonly employed surgical strategy, complemented by combination antimicrobial therapy for an average of 4.6 months. The mean follow-up time was 39.7 months, during which recurrences were observed in 21/171 patients (12.3%). Conclusion: The emergence of PMIs in relation to cosmetic medical tourism alerts clinicians to the importance of educating the public about the associated risks. In addition, this study identifies risk factors associated with recurrence of PMIs. Conflicts of Interest: None of the authors has a financial interest in this manuscript. Source of Funding: No funds were received in support of this study. Address correspondence and reprint requests to: Omar Fouda Neel, MBBS, MMgt, FRCSC, FAAP, FACS, Division of Plastic Surgery, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC H4A 3J1, Canada Phone Number: 5142249054 , Fax Number: 5142249054 , Email: foudaneel@gmail.com ©2018American Society of Plastic Surgeons