Robert Whitfield MD (speaker) describes a 2016 clinical case of a breast cancer patient who chose an aesthetic flat closure after prior implant-based reconstruction. He reviews reconstruction options (no reconstruction/aesthetic flat closure, implant-based, autologous microsurgical reconstruction), explains that he routinely removes capsular tissue for pathology when taking down implants, and reports that pathology/culture found an E. Coli infection around the implant meeting hospital criteria for infection (10^6, or 100,000+ per high-power field). There were no preoperative clues on bloodwork or imaging; the patient was treated with antibiotics and improved.
Questions this video answers
2016.
E. Coli.
10^6 (over 100,000) bacteria per high-power field.
Chapters
So in 2016, I took care of a cancer patient who just wanted to go flat. And for everybody listening, I appreciate you having me on to explain this to your audience. There's options in breast reconstruction. You can have no reconstruction and have an aesthetic flat closure, which is one of the options. You can have a implant based reconstruction, there's ways to do that. And then you can have what's called an autologous reconstruction, which is usually your own tissue. And that's what I specialized in for about 20 years, using microsurgery to sew together blood vessels to reconstruct a breast. And so this patient wanted to go flat, so they had an implant. And for everybody listening, I was trained specifically in cancer reconstruction. And when we took down a reconstruction, we'd always take all the capsular material out. That's what your body forms around an implant. So that scar capsule would always get sent to pathology so they make sure the patient didn't have recurrent cancer. We also checked to make sure there was no infection because there was an implant there. And so when I did that for this patient, all of the testing came back negative for cancer, which is obviously paramount. But she had a. E. Coli infection. Wow. So for everybody listening, E. Coli infection. You've heard of all the food poisoning that can happen with E. Coli. This was in at around her breast implant. And this was enough bacteria to truly be called an infection based on the hospital criteria, which is 10 to the 6 or over 100,000 per high power field. So that's very, very bad. Obviously, my sister passed away this past year of cancer, breast cancer specifically, and had someone miss that on her, I'd be really pissed off that that had happened. So we went back through all the data for the case and we didn't have any clues. There were nothing on her blood laboratories, there were nothing on her studies, her CT scanner, mri. There was nothing to tell you that that was, was there. So I treated her appropriately based on what was found with antibiotics, and magically, she got better.
