Simultaneous breast implant infection and acute myocardial infarction-A tricky combination

We present the case of a 57-year-old woman with a history of breast implants after augmentation mastopexy and persistent breast pain for six months. Despite a previous implant exchange with capsulectomy, the patient experienced a recurrence of symptoms for the last six months with a sudden worsening during the last night. Clinical examination revealed an asymmetry in favour of the left breast, but otherwise no clear evidence of implant- associated complication. The reported pain started retrosternally and radiated to the left scapula and arm. An acute myocardial infarction was suspected. Subsequent investigations confirmed a ST-elevation myocardial infarction. The patient received immediate cardiac catheterization, addressing an acute occlusion of the left anterior descending artery, followed by dual antiplatelet therapy. Despite successful treatment of the myocardial infarction, the patient continued to report pain in her left breast. In addition, inflammatory markers were significantly elevated. After excluding other possible sources of infection, sonography confirmed the suspicion of an implant infection. A multidisciplinary team approach guided therapeutic decision-making, balancing the high cardiovascular risk with the need to manage the implant-associated infection. Empirical antibiotic therapy and implant removal under sedoanalgesia facilitated resolution of symptoms and infection. This case highlights the importance of maintaining a broad differential diagnosis in patients presenting with breast implant-related concerns, particularly in those with concomitant cardiovascular risk factors. (c) 2024 The Authors. Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )