Abstract

Objectives: This paper aims to contribute to the limited publications regarding these two disease entities (herpes zoster and breast implant capsular contracture) and to make an avenue for further studies regarding any possible link between them. This paper also aims to enforce proper patient education regarding vaccination efforts and early recognition of signs and symptoms in order to achieve early intervention with antivirals and prevention of long-term complications in susceptible individuals both young and old. Introduction: This case report in a public tertiary hospital in the Philippines documents a rare occurrence of a patient presenting with a grade IV breast implant capsular contracture, left, which is preceded by a herpes zoster infection affecting the post-operative site at the T4 dermatome on the ipsilateral side. Shortly after the patient had noted a breast implant capsular contracture on the left, this prompted her to consult at the institution for which a surgical intervention was warranted after assessing the current condition of the patient. Materials / method: We present an 80-year-old female, with no known co-morbids, initially diagnosed with varicella during her teenager years, who was complaining of pain from both the postherpetic neuralgia and the breast implant contracture. The patient then underwent laboratory work-up and diagnostics. Cardiopulmonary clearances were requested where the patient was cleared as low-risk for the procedure. The patient underwent breast implant explantation with partial capsulectomy, left. Specimens were sent for gram stain, culture studies and for histopathologic assessment to rule out infection and malignancy. Results: Microbiological analysis of explanted tissues and fluids revealed no bacterial growth thereby ruling out ongoing infection. Histopathological examination confirmed benign findings with no evidence of malignancy thereby ruling out breast implant-associated anaplastic large cell lymphoma. The patient's post-operative course was uneventful with no subjective complains and was discharged on post-operative day three. At follow-up visits, patient reported complete resolution of pain associated with both capsular contracture and postherpetic neuralgia and a fully epithelialized post-operative site. Conclusion: The patient was managed accordingly and promptly by removal of the breast implant and capsule to rule out ongoing infection and the possibility of an implant associated malignancy. Patient’s main concern of pain, caused by the implant and as a sequela of the herpes zoster, was addressed and resolved as well according to the patient. This case report stresses the attention on this rare occurrence between herpes zoster infection and breast implant capsular contracture as management requires early diagnosis and prompt treatment.