This case involves a thirty-five-year-old female patient who was suffering diffuse physical ailments including severe neck, back, and shoulder pain all of which was caused by macromastia. Aside from these complaints the patient was in good health with no significant past medical history. The patient had tried many different treatment options in hopes of alleviating her musculoskeletal complaints including acupuncture, massage and regular appointments with a chiropractor. None of these treatments were effective and the complaints were beginning to affect the patient’s ability to work. At the recommendation of her primary care physician the patient consulted a plastic surgeon regarding a breast reduction to relieve her symptoms.
The patient chose to undergo a bilateral reduction mammoplasty on the recommendation of the treating plastic surgeon as a last resort. The surgery took place without any intraoperative complications. However, soon after the procedure the patient developed multiple symptoms including pain, redness, and purulent drainage from the surgical site on both breasts. After several tests were conducted it was determined that the patient was suffering from severe abscess formations as a result of contracting infections in both breasts. The patient underwent bilateral breast abscess drainage and pigtail catheter placement for long term antibiotic therapy. Continued antibiotic treatment was of minimal benefit as necrotic tissue developed on both breasts. The patient required several sharp debridement procedures along with extensive wound care treatment but unfortunately significant disfigurement of the breasts remained after the infections eventually resolved. The patient required breast reconstruction surgery but was left with residual scarring.
Question(s) For Expert Witness
Can you comment on the likelihood of developing bilateral infections and what are the chances this was due to a non-sterile technique or contaminated operative field? Can you determine if the patient received the proper prophylactic antibiotics?
Expert Witness Response
Infection with tissue loss is a known complication of breast reduction surgery, and for that matter, any other surgeries. A review of the pre-operative notes would assist in gaining an insight into whether or not the patient received adequate pre-operative antibiotic therapy. Prophylactic antibiotics are imperative in these types of procedures. I would like to know if the infection was superficial or deep. If this was a deep infection then there may have been a surgical planning error and the patient may not have received the proper prophylactic antibiotics. If the infection was meticillin-resistant Staphylococcus aureus (MRSA) a bacterium that is common on the skin and is resistant to a wide range of antibiotics, then there could be a delay in diagnosing and treating the infection.
About the author
Dr. Faiza Jibril
Dr. Faiza Jibril has extensive clinical experience ranging from primary care in the United Kingdom, to pediatrics and child abuse prevention at Mount Sinai Hospital, to obstetrics in Cape Town, South Africa. Her post-graduate education centered on clinical research and medical ethics. Dr. Jibril is currently Head of Sales in the US and Canada for Chambers and Partners - a world leading legal ranking and insights intelligence company.
