Authors: Al-Halabi, Becher; Viezel-Mathieu, Alex;
Shulman, Zachary; Behr, Marcel A.; Fouda Neel, Omar
Background:
Epidemiologic evidence of periprosthetic mycobacterial infections is limited.
The recent boom in cosmetic surgery tourism has been associated with a rise of
surgical-site infections in returning patients. This review aims to explore
available data, examine trends of documented periprosthetic mycobacterial
infections, and analyze outcomes of management techniques. Methods: A search in the Biosis, Embase, LILACS, MEDLINE, and Web
of Science databases from inception until December of 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 periprosthetic mycobacterial infections
in developing countries since the start of the millennium. The mean patient’s
age was 37.9 years and the majority of patients had undergone bilateral breast
augmentation. Most patients presented with breast pain or tenderness, after an
average incubation period of 9 months. Mycobacterium fortuitum was isolated
from 90 cases (52.6 percent). Immediate explantation with or without delayed
reimplantation was the most commonly used 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 recurrence was observed in 21 of
171 patients (12.3 percent).
Conclusions: The
emergence of periprosthetic mycobacterial infections 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 periprosthetic mycobacterial infections.
