Huge Abscess Formation after Megavolume Autologous Fat Transfer for Breast Augmentation--Case Report and Literature Review

巨量自體脂肪移植隆乳術後巨大膿瘍形成──個案報告及文獻回顧

Tzu-Yi Chung(鍾子毅)；Kwang-Yi Tung(董光義)；Wen-Chen Huang(黃文成)；Chia-Meng Yu(游家孟)；Ming-Feng Tsai(蔡明峰)；Wen-Teng Yao(姚文騰)；Hsuan-Yu Huang(黃宣諭)；Chieh-Ming Yu(尤傑銘)

autologous fat transfer ； breast augmentation ； megavolume fat grafting ； complications ； abscess formation

臺灣整形外科醫學會雜誌

33卷3期（2024 / 09 / 01）

319 - 330

英文;繁體中文

Background: The risks of fat necrosis and associated complications following megavolume fat grafting for breast augmentation warrant considerable attention. Although clinical instances of infection and abscess formation post-megavolume fat grafting are occasionally observed, these complications are relatively underreported in the medical literature. This case report specifically addresses a severe infection and extensive abscess formation encountered in a patient after undergoing megavolume fat grafting for breast augmentation. Aim and Objectives: This report aims to present a rare case of a huge abscess formation following megavolume autologous fat grafting, a scenario sparsely documented in the literature. By outlining the clinical challenges, management strategies, and outcomes, the report seeks to provide a deeper insight into the associated risks of such surgical interventions. This detailed exploration will contribute to a better understanding and preparedness for handling similar complications in future practices. Materials and Methods: A 33-year-old Taiwanese female underwent a megavolume autologous fat transfer surgery, receiving 450 ml of fat grafting in each breast. Postoperatively, bilateral breast infections occurred, with one side progressing to form a huge abscess necessitating surgical intervention. This study presents the diagnostic approach, surgical techniques, and postoperative care implemented in this case. Results: The patient experienced drainage of a 1300 ml abscess from the left breast. Following surgical debridement through an inframammary fold incision and antibiotic therapy, the abscess showed marked improvement. Cultures from the abscess isolated Escherichia coli and Prevotella species. Despite the severity of the complications, the patient recovered well. A 3-year follow-up revealed no significant deformity in the affected breast and minimal scarring at the incision site. Conclusion: In breast augmentation, small-volume fat grafting is lauded for its reproducibility and predictability, yet the employment of megavolume techniques is far from uncommon. Due to limited research, the effects of megavolume grafting, particularly volumes exceeding 450 ml, on infection rates and severity are not fully understood. This case study highlights that while fat grafting for breast augmentation typically boasts low complication rates, megavolume procedures, especially those over 450 ml, can significantly increase the risk of serious abscess formation. This underscores the critical importance of heightened vigilance for early signs of infection and the prompt treatment of such infections in megavolume breast augmentation procedures.

背景：在進行巨量體積脂肪移植乳房增大手術後，脂肪壞死和相關併發症的風險值得高度重視。雖然臨床上偶爾會遇到巨量體積脂肪移植後的感染和膿瘍問題，但這些併發症在醫學文獻中卻相對少有報導及討論。本病例報告專門描述了一位患者在接受巨量體積脂肪移植乳房增大術後出現的嚴重感染和大量膿瘍形成的案例。目的及目標：本報告旨在介紹一例文獻少見的巨量自體脂肪移植後形成巨大膿瘍的病例，概述臨床挑戰、處理策略和結果，以便深入了解該手術的相關風險。材料及方法：一名33歲的台灣女性接受了巨量自體脂肪移植手術，每側乳房各注射了450 ml自體脂肪。術後雙側乳房感染，其中左側發展形成一個巨大膿瘍，必須進行手術治療。本研究介紹了診斷方法、手術技巧和術後照顧。結果：患者左側乳房引流1300 ml膿瘍，經過乳房下皺襞切口的手術清創和抗生素治療後，膿瘍改善。從膿瘍培養中分離出大腸桿菌和普雷沃氏菌。儘管併發症嚴重，但患者恢復良好，三年後的追蹤乳房無明顯變形，引流切口無明顯疤痕產生。結論：雖然小體積的隆乳一般被認為具有可重複性和可預測性，但臨床使用大體積或巨量體積的隆乳並不少見。由於相關文獻稀少，巨量體積或超過450 ml的脂肪移植隆乳手術對感染率及其嚴重程度的影響尚不明確。本研究案例顯示，儘管一般認為脂肪移植隆乳手術併發症較低，但在巨量體積或超過450 ml的情況下，一旦發生感染可能會導致嚴重的膿瘍，這強調了在進行巨量體積隆乳手術時，對早期感染的高度警覺和迅速治療的重要性。