There were 20,673 Buttock Augmentations or Brazilian Butt Lifts (BBL) done in 2016, a 2-fold increase compared to the 3 years prior. Infection is a serious complication. One organism identified in lipotourism patients is nosocomial rapidly growing non-tuberculosis Mycobacteria (RG-NTM). We present a case of necrotizing pan-resistant RG-NTM infection following a domestic BBL requiring an intensive care unit (ICU) admission, prolonged hospital stay, extensive surgical debridement and extended need for systemic antibiotics.
The patient is a 27 year old female who received a BBL with autologous fat grafting in Miami, FL on March 16, 2017. She developed post-operative buttock infection. She failed outpatient treatment, was referred to our burn ICU, and was diagnosed with a necrotizing infection. She underwent serial excisions, negative pressure therapy, and complicated wound care. Diagnosis of M. abscessus was made. She was started on an experimental trial of antibiotics, and required greater than 2 months of multi-disciplinary, ICU care. She was discharged home with wound care and administration of IV antibiotics of 6-12 months.
The estimated cost of a mycobacterial infection after a cosmetic procedure to be $96,949.81. After correct diagnosis, mainstay of management is surgical debridement and prolonged antibiotics. M. Abscessus has the reputation of the most virulent and drug-resistant member of RGM group and little literature is available to support definitive treatment. In our case there was a positive outcome, but proves the need for further investigation.
As increasing infections from lipotourism, or in our case from a domestic procedure, present, prevention, early recognition, and effective treatment are important. We use our case to demonstrate the need for investigation of source control versus systemic antibiotics for adequate treatment.