Over the years, much has been discussed about the safety of injecting fillers into the face. What about the safety of injections into other areas? We highlight the management of a patient with complications following hyaluronic acid fillers in her breasts.
A 28-year-old woman presented with hemopurulent discharge from both breasts 3 weeks after 250 ml of hyaluronic acid was injected into each breast. Three days postinjection, she developed fever and skin blisters. She saw a general practitioner and was given analgesia. Seven days postprocedure, she returned to the injector, who attempted aspiration and gave her a week of oral cefuroxime. However, the pain and discharge persisted, and she came to our institution 10 days after the filler injection.
Examination revealed bilateral inferolateral quadrant fluctuance with hemopurulent fluid discharge (Fig. 1). The fluid was sent for aerobic and anaerobic cultures along with a smear and culture for acid fast bacilli. The aerobic culture yielded pan-sensitive Pseudomonas aeruginosa and the patient was commenced on ciprofloxacin.
Fig. 1.
Surrounding erythema and multiple discharging sinuses with slough on the gauze.
Our patient declined any surgical intervention and we agreed to a cautious trial of nonsurgical management with the view that if her condition were to deteriorate, we would need to proceed surgically. A trial of conservative management with daily dressing change was commenced. Over the next 3 days, the dressings became less soaked, her pain decreased, and she was discharged home. She was initially lost to follow-up but presented in the clinic 18 months later, where her breasts were noted to have healed with minimal scarring (Fig. 2).
Fig. 2.
Complete resolution in 18 months.
Minimally invasive procedures have been described to treat breast abscesses,1 but the presence of a foreign body nidus and draining sinus prompted us to recommend surgical debridement and removal of the filler. We managed to achieve satisfactory results by conservative methods for several reasons. First, our patient was a young lady with no comorbidities. Second, we observed her carefully as an inpatient and continued regular monitoring in the outpatient setting. Third, we were guided by culture results.
Complications of fillers include infections, migration, hematoma, lumps or nodules, and septic shock.2,3 Despite safer and better alternatives for breast augmentation, fillers continue to be used and doctors should be wary of this.
Local regulations prohibit fillers for breast augmentation,4 but our patient sought treatment from abroad. This case highlights the vulnerability of patients who are misinformed or uninformed about the risks of filler injections into the breasts.
We hope this letter serves as a timely reminder to patients and doctors to be careful about the potential hazards of fillers and other aesthetic procedures.5
DISCLOSURE
The authors have no financial interest to declare in relation to the content of this article.
Footnotes
Published online 29 November 2021.
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