Actinomyces of the reconstructed breast: A case report

Actinomyces species has been described as a rare cause of primary breast, abdominal, and cutaneous infections, and can present as recurrent abscesses, tissue fibrosis, and fistulous draining sinuses, particularly in the setting of immune compromise. We present a case of a 48-year-old woman who underwent bilateral mastectomy with muscle sparing transverse rectus abdominus muscle free flap reconstruction thirteen years prior and developed recurrent abscesses in her reconstructed breast, ultimately attributable to chronic infection with Actinomyces. This is the first reported case of Actinomyces infection in the autologously reconstructed breast. Definitive treatment included surgical mastotomy and debridement with vacuum assisted wound closure and prolonged course of intravenous (IV) ampicillin-sulbactam followed by oral amoxicillin-clavulanate. Actinomyces infection of the breast may present as recurrent abscesses and requires a high index of suspicion to preserve the architecture of the autologously reconstructed breast.