Mycobacterium Fortuitum Infection in Breast Implant and Rib Osteomyelitis: A Case Report and Review of Literature

Breast implant-associated Mycobacterium fortuitum infections with presumed rib osteomyelitis are exceedingly rare, with fewer than seven cases reported globally. We report the first documented case from Latin America, identified through systematic review of PubMed and SciELO databases. A 25-year-old woman with no predisposing comorbidities underwent mastopexy and breast augmentation with a retropectoral silicone implant. She developed a persistent left breast wound unresponsive to conventional treatment at an outside institution and was referred to our center approximately 14 months postoperatively with a chronic fistula and rib exposure. A multidisciplinary approach (plastic surgery, orthopedic surgery, and infectious disease) was employed. Serial surgical debridement with vacuum-assisted closure (VAC) therapy was performed. Cultures confirmed M. fortuitum sensitive to clarithromycin and doxycycline; combination therapy with clarithromycin and moxifloxacin was administered for 6 months. Wound closure was achieved with epigastric and thoracoabdominal pedicle flaps, followed by bilateral autologous fat grafting for breast reconstruction. At 8-year follow-up, the patient reported satisfaction with the aesthetic result. This case emphasizes the importance of maintaining clinical suspicion for nontuberculous mycobacterial (NTM) infection in chronic non-healing wounds following breast implant surgery, even in immunocompetent patients without identifiable risk factors.