Postsurgical pyoderma gangrenosum following breast surgery: a case report of two patients with delayed versus early diagnosis

Postsurgical pyoderma gangrenosum (PSPG) is a rare, noninfectious neutrophilic dermatosis that can occur after breast surgery. Because it closely mimics a surgical site infection, the diagnosis is often delayed, and repeated surgical interventions may aggravate the disease through pathergy and result in extensive tissue loss and poor aesthetic outcomes. Therefore, early diagnosis is important. We report two cases of PSPG following breast surgery with contrasting clinical courses associated with delayed vs. early recognition. In Patient A, bilateral wound necrosis was misdiagnosed as an infection and treated accordingly, which led to multiple surgical interventions, including implant removal, flap reconstruction, and skin grafting. In Patient B, who presented with a similar picture, PSPG was suspected at presentation and systemic corticosteroid therapy was started one week after surgery, followed by rapid clinical improvement with the need for only one superficial necrosectomy after disease stabilization, which led to an acceptable aesthetic outcome. These cases show that atypical postoperative wound ulcerations or healing disturbances after breast surgery should raise suspicion of PSPG, particularly when cultures remain negative and wounds fail to respond to antibiotics. Increased awareness may allow earlier immunosuppressive treatment and help to avoid unnecessary surgical procedures.