Atypical Pyroderma Gangrenosum after Breast Reduction

Although rare, pyoderma gangrenosum (PG) occurs as one of the worst local complications following plastic surgery to the breast. The early manifestations are similar to a necrotizing wound infection, so diagnosis and correct management are often delayed. Failure of response to the aggressive treatment strategies needed for necrotizing wound infections and the phenomenon of pathergy will often raise the clinical suspicion of PG. The main steps of therapy consist of minimal wound debridement and initiation of corticosteroids and/or immune modulation. Repair of skin defects requires care and attention. Smaller defects are best left to heal by secondary intention, as pathergy can reactivate the syndrome and cause an even larger skin wound. Larger defects are repaired with skin grafts or flaps. We report a case of atypical (bullous) PG in a healthy 57-year-old white woman following reduction mammaplasty.