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Successful revision surgery after postsurgical pyoderma gangrenosum following reduction mammaplasty: A case report
Lindsay A Tao1, Carolyn Cafro2, Micaela Rosser1
1University of California, San Francisco, Department of Surgery, Division of Plastic and Reconstructive Surgery, San Francisco, CA, USA.
Background:
Postsurgical pyoderma gangrenosum (PSPG) is a rare neutrophilic dermatosis that occurs following surgical procedures and frequently mimics postoperative infection. Misdiagnosis may lead to repeated surgical debridement and disease progression due to pathergy. Reports describing safe reoperation following PSPG remain limited, creating uncertainty regarding subsequent reconstructive procedures.
Case:
We report the case of an 18-year-old woman with well-controlled perinatal HIV who developed PSPG following bilateral reduction mammaplasty. On postoperative day (POD) 2 she developed refractory fevers and blisters near the vertical incision. By POD 6, ulceration developed on the left breast T-junction, prompting hospital admission. Dermatologic consultation and biopsy confirmed neutrophilic dermatosis consistent with pyoderma gangrenosum (PG). Multidisciplinary management involving dermatology, infectious disease, and plastic surgery led to initiation of systemic corticosteroids and immunomodulatory therapy, resulting in progressive clinical improvement and complete wound healing by eight months. After sustained disease remission and negative pathergy testing, the patient underwent staged reconstructive revision to address hypertrophic scarring and contour deformity. Revision mastopexy and autologous fat grafting were performed while the patient remained on biologic immunomodulatory therapy, with operative techniques modified to minimize cutaneous trauma. The patient healed without recurrence of PG.
Conclusion:
Postsurgical pyoderma gangrenosum presents a unique challenge for reconstructive surgeons because surgical trauma may trigger disease progression or recurrence through pathergy. This case demonstrates that revision surgery may be feasible after PG remission when disease control is sustained and perioperative management is coordinated with dermatology. Continued immunomodulatory therapy and surgical techniques that minimize cutaneous trauma may help mitigate recurrence risk and facilitate safe reconstructive revision.
