Post Op Infection Question

[shzlaw2]

Hello,

I had a breast augmentation on 11/6 and was given IV antibiotics as well as 3 days of erythromycin post op. I must admit, 3 days didnt seem like much. Now, I've been diagnosed with an infection in my left breast, drainage, pain, fever, etc. Now, I'm on Levaquin while I await a culture. In your experience, have you successfully treated infection with antibiotics rather than additional surgery? Or have ever had to go directly back to the OR for drainage or removal?
I really appreciate your time and any information you may be able to provide.
Stephanie

[Dr. Mele]

Dear shzlaw2:

Thank you for your question. The most important dose is the intravenous dose of antibiotics given before surgery. This has been shown to decrease the risk of operative site infections. While most plastic surgeons do keep their breast augmentation patients on antibiotics longer (24 hours to 7 days after surgery), studies do not show any benefit for these extra doses. So one dose IV within an hour of starting surgery is as effective as one dose IV plus one day, three days or a week of oral antibiotics after surgery. The problem is these are prophylactic antibiotics and there is no culture to be certain these are the correct antibiotics.

As long as you are not septic, there is time to take a culture and give a trial of targeted antibiotics. Levaquin covers a broad range of bacteria and is an excellent choice for most the common bacteria cultured around infected breast implants. An adjustment maybe needed depending the bacteria cultured and sensitivity of this bacteria.

The effectiveness of oral antibiotics can be as high as 50%. If successful the implant can stay in place. The alternative is to remove the implant, treat the infection and several months later (six) replace the implant. This means at least two operations (removal and replacement if desired) If you become septic, or have signs of worsening infection despite the antibiotics, the implant should be removed.

Sometimes the infection is in the skin or breast tissue rather than around the implant, and these types of infection tend to respond better to oral antibiotics. I cannot tell which is the best treatment for your situation, so the above is really just general information. If you are feeling worse, have increasing pain, redness, discharge or fever, you should contact your plastic surgeon immediately. If they are not available, you may need to see your primary medical doctor or go to an emergency room. This is not as ideal as they will not have previous examinations to compare, but if the infection is worsening, it should be treated sooner rather than later.

[shzlaw2]

Thanks very much for the detailed information. It gives me some important questions to pose to my surgeon at my follow up appt.
Again, thanks for your time.