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QUESTION

Having a Fistulogram for Breast with an Implant?

What do you think of having a Fistulogram for an augmented breast? To give you a little background, I have a hole under the breast / right in the crease area that would not heal (my incision is via areola) I am concerned about the danger of having iodine injected in my breast with the implant there. What are the risks of a Fistulogram? And alternatives or other methods to diagnose the problem? My breast is already inflamed with all things going on (although the fluid had been cultured and it showed no growth)... my surgeon and myself had tried to manually 'collapse' what he thinks is a cavity but have no success... Thank you in advance for your response.

ANSWER

Fistulogram and Breast Implants

Thanks for the question. You describe a bit of an unusual problem. It is strange to have a fistula as you describe that is not connected with the original incision. Typically, infections or healing problems manifest themselves at the weakest point, which in the immediate post-op period is at the original incision - your areola. Previous incisions or radiation can change this somewhat. If you've had the implants for a while and developed a new draining wound in the breast crease, this likely represents a manifestation of an infected implant. In this case, it would be unlikely that the implant would be salvageable, making the fistulogram unnecessary. Other modalities which can provide information include ultrasound, MRI, tagged white cell scans and CT specifically looking for fluid collections or inflammation around the implant. Most of the time it is not necessary to use any of these techniques as exposed or infected implants typically have strong symptoms diagnosed on physical exam. In addition, be careful of using iodine-based contrast for your fistulogram. Hypaque or other water soluble dye may be the better choice, as iodine based products damage the implant shell and void the warranty. I hope this helps.

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