Outcomes and Risk Factors of Pyoderma Gangrenosum After Reduction Mammoplasty: A Systematic Review of the Literature and Case Report

TL;DR

This paper reviews the risk factors and outcomes of a rare skin condition called pyoderma gangrenosum that can develop after breast reduction surgery.

Contribution

The study provides a systematic review and case report highlighting the risk factors and management of post-reduction mammoplasty pyoderma gangrenosum.

Findings

The median time to initial presentation of pyoderma gangrenosum was 6.5 days after surgery.

Most cases were misdiagnosed as wound infections, leading to ineffective treatments.

Immunosuppressive drugs were effective in healing ulcerative lesions in the reported case.

Abstract

Reduction mammoplasty is a common aesthetic and reconstructive breast procedure. Pyoderma gangrenosum (PG) is a rare inflammatory, non-infectious neutrophilic dermatosis. Post-surgical PG is characterized by ulcerative lesions at surgical sites commonly misdiagnosed as wound infection. The present systematic review was conducted to retrieve the potential factors and outcomes of post-reduction mammoplasty PG with a case report.

An extensive systematic literature review was implemented from inception to 18 October 2024. All clinical studies that included patients with PG after reduction mammoplasty were included for systematic review.

A female patient presented ten days after reduction mammoplasty with bilateral wound dehiscence. Thirty-nine days after the operation, the wound showed a second dehiscence for which immunosuppressive drugs were prescribed. The patient responded to the latest regimen with complete healing of the ulcerative lesions of the right and left breasts. The present systematic review included 41 cases, encompassing the present case report. The median time to initial presentation of PG was 6.5 days. The median time to the diagnosis of PG was 15.5 days. The wound was healed by secondary intention among 26 (59.06%) patients. Skin grafting was performed for six (13.63%) patients, while three (6.81%) patients received skin substitutes.

PG after reduction mammoplasty is a devastating condition associated with poor cosmetic outcomes. The condition is difficult to diagnose, and the majority of cases are misdiagnosed and potentially subjected to ineffective medical therapy and unnecessary surgical debridement that worsen the prognosis of PG. Patients with existing immunological disorders and patients with a history of breast cancer were at higher risk of developing PG after reduction mammoplasty. The risk of PG after reduction mammoplasty still existed despite undergoing previous breast or abdominal surgeries. Patients with post-reduction mammoplasty PG mostly presented with erythema, severe pain, and fever.

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