Autoamputation of the Breast Following Necrotizing Fasciitis: A Case Report and Review of Literature

Abstract

Autoamputation of the breast as a sequela of severe pyogenic infection is a rare surgical condition. Severe pyogenic infections or Necrotizing Soft Tissue Infection (NSTI) may lead to, thrombotic vasculitis, rapid tissue necrosis and ultimately, detachment of the breast if misdiagnosed or left untreated. Imaging techniques like contrast-enhanced computerized tomography, and ultrasound scan play crucial roles in the early diagnosis, often with findings of subcutaneous gas, tissue edema, and fascial fluid collections serving as important differentiators from abscess and cellulitis.
I report a 25-year-old woman who presented with complaints of pain in her left breast, left breast swelling and left breast ulcer of eleven (11), seven (7) and four (4) days duration respectively, shortly after weaning her baby. She has no history of sickle cell disease, hypertension or diabetes mellitus.

On examination, the left breast was enlarged with circumferential eschar, and oedematous surrounding skin. The nipple was inverted. The ipsilateral (left) axillary nodes were palpably enlarged. The contralateral (right) breast and axilla were essentially normal.

Breast ultrasound scan revealed subcutaneous gas, tissue edema, and fascial fluid collections in the affected breast.

An assessment of necrotizing fasciitis of the left breast secondary to a poorly treated lactational mastitis was made. She subsequently developed an autoamputation of the affected breast caused by severe pyogenic infection, which rapidly progressed to a necrotizing fasciitis. A wedged biopsy was taken for culture and histology. The culture yielded Escherichia coli sensitive to cefuroxime and Gentamicin. The specimen showed acute inflammation of the skin, soft tissue destruction, extensive breast tissue necrosis, necrotizing arteritis, venous thrombosis (consistent with features of necrotizing fasciitis), and an incidental finding of a tubular adenoma on histological examination.

Her management involved timely initiation of broad-spectrum antibiotic therapy, surgical debridement, and proper wound dressing. The wound healed nicely, thus she was counselled and referred to the reconstructive surgeons for breast reconstruction.

This case highlights the importance of maintaining a high index of suspicion in making the diagnosis of necrotizing fasciitis of the breast. Prompt decision-making and multidisciplinary management can reduce morbidity and prevent such tragic outcome as autoamputation.

Furthermore, a de-escalation therapy to a narrower spectrum of antibiotics is encouraged, after reviewing culture and sensitivity results.