Acute Presentation of Pyoderma Gangrenosum: A Rare Complication Following Augmentation Mastopexy–A Case Report and Strategies for Prevention

Abstract Pyoderma gangrenosum (PG), as a complication of aesthetic surgery, is an unpleasant experience for both the surgeon and the patient. It can have serious health consequences and cause both mental and physical suffering. In some cases, it may be accompanied by the development of a systemic inflammatory response, which can be life-threatening, and may even represent the first manifestation of an autoimmune, systemic, or oncological disease. We present the case of a patient in her mid-40 s with autoimmune hypothyroidism on substitution therapy. Following bilateral periareolar mastopexy with augmentation, the patient developed fever and bilateral wound complications on postoperative day 5, including redness, swelling, wound exudate, ulceration, and dehiscence at the surgical incision sites, with subsequent progression to sepsis-like systemic inflammatory reaction/ severe systemic inflammatory response. Rapid consideration of pyoderma gangrenosum as a potential diagnosis led to implant removal and initiation of corticosteroid therapy on day 8. The patient reported subjective improvement within 24 h following corticosteroid administration, with an early reduction in body temperature and overall clinical improvement. Thanks to early recognition (from symptom onset to initiation of corticosteroid therapy and implant removal), we were able to prevent further deterioration of the local findings and avoid progression to severe sepsis within 10 days. Corticosteroid therapy was continued for nine months, together with supportive wound care, until full recovery. Subsequent evaluations did not reveal any new autoimmune or oncological diseases in this patient. We present new protocols and an algorithm at our department for managing similar situations, as well as for preoperative risk stratification and postoperative monitoring in aesthetic breast surgery, incorporating multidisciplinary consultations and tailored immunosuppressive strategies to reduce the incidence of PG and improve patient outcomes.