Failed recon due to infection- treatment questions??

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happyteacher
happyteacher Member Posts: 118
edited June 2016 in Breast Reconstruction

Hello,

I have a few questions regarding failed reconstruction due to infection. On one of my previous attempts to replace the implant during the surgery to take out scarring and replace the implant, it was known once the surgeon went in there that the problem was an infection. There was tissue/colonization consistent with infection, and he sent it off to the lab to confirm and determine the nature of the infection. He then irrigated the surgical site and the pig/cow tissue used, reused the pig/cow tissue and put in the new implant. Fast forward three months and the implant was horribly swollen and infected with the same strain (Pseudomonas aeruginosa), which is a drug resistant strain that you get when the hospital doesn't properly sterilize, proper hand washing, etc. (HAI infection).

I have been thinking about this, as I am now recovering from having both implants removed and throwing in the towel on the reconstruction process. The lab results came back showing that the infection that caused the scarring from implant he reused the tissue on is the same strain. So my question, what is the typical procedure for dealing with an infected implant site? I thought I read that if you have an infection a normal course of action is removing the implant and then wait a substantial period of time before going back in? Is this accurate?

At my follow-up yesterday I had to ask him about the lab results. He clearly had not reviewed them and missed that not only was it the same strain, but that due to it being drug resistant perhaps it is not safe to assume a normal course of doxycycline (sp?) would take care of it. He did say that he "likely" will give me a referral to an infections disease doc in two weeks when I go back in for a follow-up. He didn't refer me this time when pressed due to wanting to research this a bit and find someone to refer me to. I am worried about this. I have no reason to think that the infection is gone- I am nausous and feel like some of the same symptoms are present as prior to surgery. He said it was Ok and waiting would be Ok. I have finished my antibiotics, so the next two weeks I will not have antibiotics. What are people's thoughts on this- am I being a nervous nelly, and waiting shouldn't be a problem or should I just call a infectious disease doctor and go in now?

A big thank you to the site. I posted a thread last week asking folks for what type of doctor I would see given my situation and feeling like he wouldn't catch the issue. They came back with the infectious disease doc. That helped me in my follow up yesterday to have a more cogent conversation about what I am dealing with. I shudder to think about what might have happened if I had not checked my lab results and researched the strain a bit to discover it is an HAI super bug type infection resistant to drugs.

Thanks for listening-

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  • tangandchris
    tangandchris Member Posts: 1,855
    edited June 2016

    Hello

    I dealt with the same infection and you NEED to see an infectious disease doctor. I'm not trying to scare you, but this is a serious bug and it is very hard to get rid of. I had to do a few rounds of IV antibiotics and have my TE's removed and still had trouble. In all honesty I'm surprised your doctor hasn't already refered you to ID, I think you should insist on it and while I'm not a doctor....I do not think it is okay to wait. Did you have surgery to remove the implant already?

    ((hugs))

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  • myToyStory2
    myToyStory2 Member Posts: 162
    edited June 2016

    I don't have any answers for you, but just wanted to send my support your way. I'm currently hospitalized for the 2nd time for pseudomonas since my May 16th bmx. I've spent 13 days of June here and had two surgeries to try to battle this. The first surgery was to remove a necrosis spot and and receive IV antibiotics. This second surgery was to remove the TE, clean out the area, remove more skin, and replace with new TE and alloderm. I've been on IV antibiotics for 8 days. Kind of keeping my expectations low for future reconstruction as I'm recognizing the seriousness of this disease. The bummer of it all - it's my prophylactic side...ugh! Will be watching this thread to hear from those who have "been there/done that". Best wishes!

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  • happyteacher
    happyteacher Member Posts: 118
    edited June 2016

    If you don't mind me asking- what was observed that triggered the hospitalization? I, at the moment, have a very poor understanding of what symptoms/progression of infection looks like. I am also wondering if we both might benefit from being more specific for the post title and citing the infection name. Not sure if I can edit the post title, but I will try.

    I am so sorry to read you are not only having to deal with it, but that it is on the prophylactic side. I am keeping my fingers crossed it works out well for you. My infection was also left side. He removed tissue on both of the prior surgeries, but I don't think I was dealing with any necrotic issues. I know for me, the 2nd implant resulted in such severe swelling it made the skin ultra thin and it gave out. Hence, had I elected to try to continue the reconstruction process i would have needed to take muscle and tissue from my back. I didn't realize that could happen, and thought going into the follow up appointment that he could just use a needle to pull out extra fluid. I was shocked to learn that I needed immediate surgery for removal. Just letting you know in case something similar happens to you-

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  • tangandchris
    tangandchris Member Posts: 1,855
    edited June 2016

    Mine was on the prophy side as well and it made it all the more awful. I was hospitialized as well, but that was to get the IV antibiotics going in my system. I also had 2 surgeries for this problem, one to remove the TE and the other was to remove necrotic tissue, once that was done my healing came about much sooner. I think mine was complicated by the fact that I was getting chemo at the same time, my body was just never able to quite kick the bug out.

    For me the hospitialization was triggered by the fact that it was psedomonas and I required IV antibiotics, this was faster than waiting to get into an ID appointment. If you are in the hospital with psedomonas, the on call ID will come in and see you there.


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  • happyteacher
    happyteacher Member Posts: 118
    edited June 2016

    Thank you tangand,

    I had both implants taken out and do not plan on any further attempts at reconstruction, so hopefully the lack of the foreign material in my will help to kick the bug quicker. I am so sorry you had to endure chemo plus surgery plus the bug. Thank you for letting me know about the hospital part- I read online that in some instances IV antibiotics go on for a month or two. Ugh. I hope you are healing and feeling better. I will post as I learn more so you have a point of reference as well. Thank you for responding-

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  • myToyStory2
    myToyStory2 Member Posts: 162
    edited June 2016

    My symptoms the 2nd time included redness, bleeding, fever, and my mastectomy scar started looking compromised. My drain output became cloudy and small amounts of pus were evident. I also had pain on the right side that couldn't be controlled by meds. Because I had previously been diagnosed and hospitalized for pseudomonas and cellulitis, I was told to pack my bags and was re-admitted to the hospital immediately after my phone conversation with the on-call PS. Now at home, I'm continuing to fight this with a 14-day supply of oral antibiotics - which was the course of action the last time, too.

    Hope your healing is going well!

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