Simply Do Not Go Snowboarding 2 Weeks after Augmentation

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A 20-year-old woman presented to our department with wound dehiscence and implant exposure of the left breast after blunt chest trauma due to a snowboard fall (Figs. 1, 2). She had a history of augmentation mammaplasty with 450 cc implants, implanted dual plane, in an outpatient clinic abroad 2 weeks prior. The plastic surgeon did not object to performing the procedure and told the patient participating in alpine sports 2 weeks after surgery was allowed when the patient informed him about the planned holiday.
Preoperative clinical examination and ultrasound evaluation excluded hematoma and implant rupture. Antibiotic treatment was started preoperatively (cefuroxime 1.5 g, intravenously) and continued orally for 10 days. Surgical intervention was started by careful, sterile irrigation of wound and exposed part of the implant with povidone–iodine, without opening the already adherent implant pocket (Fig. 1). Careful debridement of the skin wound was performed followed by a multilayered wound closure with deep subcutaneous 2.0 and 3.0 Vicryl sutures and a running intracutaneous Monocryl 4.0 suture. Immediate postoperative course was uneventful and the patient could be discharged at the next day.
Carrying out a literature review in January 2017 using PubMed database, we did not find an article discussing the surgical approach to breast implant exposure after trauma in healthy women. In general, only 41–4 articles discussed the problem of implant exposure itself without specifying the underlying cause. The majority of cases suffered from infection but had no history of trauma. Nevertheless, these articles also report successful breast implant salvage in the majority of these cases.1,2 Weber and Heintz1 recommended the same technique of implant salvage we performed.
As a conclusion, the authors of this article wanted to point out that serious patient education is essential, especially after aesthetic procedures. We do not recommend performing sports for 6 weeks after augmentation mammaplasty. In our case, we decided not to completely remove the breast implant out of the pocket as additional surgical manipulation may have increased the risk of bacterial contamination of the whole implant surface. We agree with the authors of the cited articles1,2 that long-term evaluation of the salvaged implant is essential, especially concerning capsular contracture and late surgical-site infection.
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