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Postsurgical Pyoderma Gangrenosum in Breast Surgery: An Updated Systematic Review, Takeaways, and the 6 Commandments.

Giorgio Caddia, Delphine Voulliaume, Laura Dettori

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    Summary

    Postsurgical pyoderma gangrenosum (PSPG) is a rare breast surgery complication. Early recognition of key signs like pain and nipple-areola sparing is crucial for timely treatment and better outcomes.

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    Area of Science:

    • Dermatology
    • Plastic Surgery
    • Surgical Complications

    Background:

    • Postsurgical pyoderma gangrenosum (PSPG) is an under-recognized inflammatory condition following surgery.
    • Its presentation after breast procedures often mimics infection, delaying diagnosis and treatment.
    • This can lead to significant aesthetic and functional consequences.

    Purpose of the Study:

    • To update the literature on PSPG after breast surgery.
    • To provide clinicians with tools for early recognition and management.
    • To offer practical diagnostic and therapeutic guidelines.

    Main Methods:

    • Systematic review conducted in March 2025, adhering to PRISMA guidelines.
    • Included studies published from 2017 onwards, updating previous work.
    • Analyzed data from 65 new cases and reported 4 institutional cases.

    Main Results:

    • Identified 65 new PSPG cases, with reduction mammoplasty as the most frequent trigger.
    • Common symptoms include pain (86.2%), with nipple-areola complex sparing in 80.7%.
    • Elevated C-reactive protein (CRP) was frequent, and cultures were often negative; systemic corticosteroids were most effective.

    Conclusions:

    • PSPG poses a diagnostic challenge with severe consequences if missed.
    • Key indicators include exaggerated pain, nipple-areola sparing, elevated CRP, and poor antibiotic response.
    • A practical diagnostic flowchart and management principles are proposed, emphasizing preoperative counseling.