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Fistulogram for Breast with Implant?
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.
Clinical Context
If a wound near an implant is draining, doctors often look first at physical signs like warmth, swelling, and drainage before ordering scans. Imaging tests like ultrasound or MRI can show fluid collections but can't always confirm infection on their own. Specialized scans exist but take longer and aren't always readily available. In most cases, a thorough physical exam by your surgeon remains the most useful step in deciding whether the implant needs to come out.
