Neal Handel, MD Barbara B. Hayden, MD William H. Jervis, MD Patrick G. Maxwell, MD Dr. Handel: Every plastic surgeon in practice encounters augmentation patients in need of revisionary surgery. This panel will discuss management of some of the common complications of breast augmentation that may require secondary surgery. The first case is that of a 34-year-old woman who underwent augmentation with subpectoral silicone gel-filled implants. She received intraoperative Ancef and postoperative oral Keflex. Ten days after surgery, she noted erythema and a small amount of drainage from the left periareolar incision (Figure 1). Culture and sensitivity studies at that time revealed 1+ Staphylococcus aureus. Dr. Hayden, in your practice, do you routinely use prophylactic antibiotics in breast augmentation patients? How would you manage this case? Figure 1 Postoperative views of a 34-year-old woman 10 days after routine augmentation with subpectoral silicone gel implants. She received intraoperative Ancef and postoperative Keflex. She noted erythema and slight drainage from the left periareolar incision 10 days postoperatively. Dr. Hayden: I do use antibiotics prophylactically, as I frequently use drains in the perioperative period. I continue antibiotics for at least 48 hours after drain removal. I would manage this case by first determining whether this is a superficial wound infection or a periprosthetic infection. The clinical exam will most likely define the extent of the problem. Focal tenderness around a limited wound would suggest a very localized problem. Induration, erythema, and tenderness around the device, along the dependent portion of the implant pocket, and along the inframammary fold would suggest a periprosthetic infection. This patient's photographs are suggestive of a localized infection, such as a stitch abscess. The diagnosis can be confirmed by wound exploration in a minor procedure room to see whether the local wound communicates with the implant pocket. If the problem seems …