Abstract
Augmentation mammoplasty is one of the most popular cosmetic surgeries, but there
is a high reoperation rate (29.7%) commonly due to capsular contracture, implant malpositioning,
infection, and unsatisfactory size. Although infection only accounts for 2% of cases,
its management is very challenging, especially with nontuberculous mycobacteria (NTM)
infection. Breast prosthetic NTM infection is a rare but is a disastrous condition
with an incidence of approximately 0.013%. Immediate salvage reimplantation is usually
not suggested, and most studies recommend a gap of 3 to 6 months after combination
antibiotics therapy before reimplantation. However, delayed reimplantation often leads
to great psychological stress and struggle between the doctor and patient. We present
the case report of successful reimplantation in treating prosthetic NTM infections
in a 28-year-old female. We discuss a novel technique “transaxillary capsulorrhaphy”
to correct the bottoming-out deformity. One year after the combination of antibiotics
and surgery, the follow-up computed tomography scan showed complete remission of NTM
without recurrence. We discuss the surgical technique in detail. The 1-year follow-up
assessment (photos and dynamic video) revealed good cosmesis and reliable correction
using the new technique. This report is the first formal description and discussion
of one-stage reimplantation following NTM infections. Transaxillary capsulorrhaphy
allows for a successful salvage operation when an implant is displaced. This approach
provides highly favorable result in eastern women undergoing revision augmentation
mammoplasty. This study reflects level of evidence V, considering opinions of respected
authorities based on clinical experience, descriptive studies, or reports of expert
committees.
Keywords bottoming-out deformity - capsular flap - transaxillary capsulorrhaphy - mycobacterial
infection
