Late infection of a breast prosthesis with Enterococcus avium

Infection in aesthetic breast augmentation occurs infrequently, with an overall incidence of about 1 percent. When an organism is cultured, the usual pathogen is S. aureus. Because most infections occur in the first few weeks or months after implantation, there is a paucity of data on infections that occur years after the original surgery. We describe a case of an infected breast prosthesis in a healthy woman, 16 years after augmentation mammoplasty, in which purulent material was found around and also inside of the ruptured silicone implant. Intraoperative cultures revealed an unusual infecting organism, E. avium, with no definite cause of the infection. A discussion of endogenous bacterial flora, predisposing factors for breast implant infections, the relationship between infection and capsular contracture, and prosthesis salvage is presented. It remains to be determined whether this case is a random event, or is representative of late implant infections, in terms of lack of clear-cut etiology and rarity of the offending organism. This breast prosthesis infection following augmentation is unusual in its late presentation and in the type of organism isolated. This case serves to heighten awareness about the possibility and consequences of late implant infections. Even though the source of this infection remains unknown, a number of possible causes have been suggested that underscore the continued importance of good hygienic breast care, antibiotic coverage during invasive procedures, and early treatment of bacterial infections elsewhere in the body, even years after implantation.