Necrotizing fasciitis after breast augmentation: rapid microbiologic detection by using sonication of removed implants and microcalorimetry.

[OBJECTIVES] To describe the use of sonication and microcalorimetry in diagnosing necrotizing fasciitis in a 27-year-old woman with bilateral breast implants.

[METHODS] The removed breast implants were subjected to sonication and microcalorimetry. The microcalorimetry findings were correlated with conventional microbiologic methods. The time to detection of infection was noted.

[RESULTS] The patient had painful cellulitis of the right breast that enlarged within hours. Her C-reactive protein level was increased. Chest radiograph showed gas formation in the soft tissue lateral of the right breast. Surgery was performed: 300 mL (right breast) and 100 mL (left breast) of serous-purulent fluid were evacuated. Streptococcus pyogenes was cultured from the fluid 1 day after clinical presentation. Infection was diagnosed by microcalorimetry of sonication fluid in 1 hour and 21 minutes. The microcalorimetry curve from the right implant reached the peak earlier than did the left implant.

[CONCLUSION] Microcalorimetry will have a benefit in conditions in which rapid diagnosis of infection is important.