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Tissue expander with acellular dermal matrix for breast reconstruction infected by an unusual pathogen: Candida
1Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, CA, United States.
Abstract:
Infections occur in approximately 2-5% percent of women undergoing breast reconstruction by tissue expansion depending on patient characteristics and timing of reconstruction. Bacteria, specifically Staphylococci, are the most common pathogens. Treatment varies depending on the surgeon and the aggressiveness of the infection. We report a case of unilateral tissue expander infection with Candida parapsilosis in an otherwise healthy female undergoing immediate tissue expander placement after bilateral nipple-sparing mastectomies. The patient was treated with a one-stage irrigation, debridement, and tissue expander exchange as well as a 21-day course of oral antifungal therapy. Her infection resolved and she was able to complete her implant-based reconstruction. C. parapsilosis is usually responsible for infections in critically ill patients found in association with central lines, peritoneal dialysis catheters and prosthetic heart valves. The affinity of C. parapsilosis for foreign material makes it a causative agent worth considering in difficult to treat tissue expander infections.
Insights
Tissue expander infections are common, but Candida parapsilosis is a rare cause. This case highlights its potential role in difficult-to-treat infections, even in healthy patients, after breast reconstruction.
Area of Science:
- Plastic Surgery
- Infectious Diseases
- Mycology
Background:
- Infections complicate 2-5% of tissue expander breast reconstructions.
- Bacterial pathogens, particularly Staphylococci, are most common.
- Treatment strategies for infections vary.
Observation:
- A rare case of unilateral tissue expander infection caused by Candida parapsilosis is presented.
- The patient underwent immediate tissue expander placement after bilateral nipple-sparing mastectomies.
- Candida parapsilosis typically infects critically ill patients with foreign materials like central lines.
Findings:
- The patient received a one-stage irrigation, debridement, and tissue expander exchange.
- A 21-day course of oral antifungal therapy was administered.
- The infection resolved successfully, allowing completion of implant-based reconstruction.
Implications:
- Candida parapsilosis should be considered in refractory or unusual tissue expander infections.
- The organism's affinity for foreign materials is relevant in prosthetic infections.
- This case expands the understanding of potential pathogens in breast reconstruction complications.
