Reduction
mammaplasty is a common procedure performed by
plastic and reconstructive surgeons to relieve chronic back and
neck pain associated with macromastia, with the added benefit of an improvement in the aesthetic contour of the ptotic breast. Complications related to this procedure are fortunately uncommon, but include
hematoma,
infection, and
wound breakdown. The authors report an interesting case of reduction
mammaplasty complicated postoperatively by
pyoderma gangrenosum (PG), which is a rare inflammatory disorder leading to progressive skin
necrosis. The destructive process, which involved both breast incisions, was managed successfully with immunosuppressive therapy and intensive
wound care, followed by a novel method of coverage with a dermal regeneration template and subsequent epidermal autograft that led to stable coverage of the open
wounds. PG is frequently misdiagnosed as a necrotizing
infection, leading to improper
debridement with exacerbation of the disease process. The mainstay of
therapy for PG is still nonoperative and focuses on immunosuppressive medications and local
wound care, which allows healing in most cases. However, there are a few indications for surgical intervention, including significantly large
wounds that are refractory to medical management. It is important for
plastic surgeons and other clinicians to be cognizant of this entity, as a delay in diagnosis and management of PG can lead to serious consequences, with considerable soft tissue loss and disfigurement of the breast.