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Complications of Methylene Blue Dye in Breast Surgery: Case Reports and Review of the Literature

Reyes F, Noelck M, Valentino C, Grasso-Lebeau L, Lang J - J Cancer (2010)

Bottom Line: Introduction: Methylene blue dye has been used worldwide successfully with few complications in breast surgery.She required multiple debridements and had granulomas masquerading as cancer on MRI that confounded her extent of disease.Conclusions: The use of methylene blue dye in breast surgery is not without risk.Methylene blue may cause not only significant morbidity, but may also produce cosmetically unsatisfactory results.

Affiliation: 1. Department of General Surgery, Division of Surgical Oncology, University of Arizona, Tucson, AZ 85724, USA.

ABSTRACT

Introduction: Methylene blue dye has been used worldwide successfully with few complications in breast surgery. We present two different complications involving methylene blue: 1) skin and parenchymal necrosis when dye was injected in a subdermal fashion and 2) Mycoplasma infection caused by contaminated methylene blue in breast reduction surgery.Methods: We present two cases seen at the University of Arizona during 2008 and referred to a breast surgeon for management. We evaluated and managed complications of methylene blue dye injected by 2 referring surgeons for different indications. A review of the literature was performed.Results: The first case is a 67 year old female diagnosed with infiltrating ductal carcinoma of the left breast for which she was treated by her initial surgeon with left segmental mastectomy and sentinel node biopsy. The operating surgeon injected methylene blue in a subareolar subdermal fashion (distant from the primary tumor); unfortunately the patient suffered skin and breast necrosis requiring multiple surgical debridements and finally achieving delayed primary closure. The second case is a 45 year old female with infiltrating lobular carcinoma with a history of Mycoplasma infection secondary to methylene blue injected for breast reduction surgery. She required multiple debridements and had granulomas masquerading as cancer on MRI that confounded her extent of disease.Conclusions: The use of methylene blue dye in breast surgery is not without risk. In both cases methylene blue was responsible for complications requiring surgical debridement for local wound problems. In each case severe necrosis and infection were present. Methylene blue may cause not only significant morbidity, but may also produce cosmetically unsatisfactory results.

The breast is shown after wound VAC sponge removal and delayed primary closure over drains. Note the volume loss secondary to the MBD skin and breast necrosis.
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Figure 4: The breast is shown after wound VAC sponge removal and delayed primary closure over drains. Note the volume loss secondary to the MBD skin and breast necrosis.

Mentions: We subsequently admitted the patient to the hospital to perform an incision and drainage (I&D) of her left breast unresolving abscess cavity. We made an incision in the area of maximal fluctuance in the left breast in the periareolar region at 5 o'clock. To explore the borders of the cavity, we used a lacrimal probe; we noted that the cavity was connected to the sinus in the 8 o'clock position. The cavity measured approximately 8cm x 7cm x 2.5cm and contained necrotic tissue. Then, we made a separate incision over the sinus in the 8 o'clock position and completely excised the tract. Once we debrided the cavity, we placed a wound vacuum-assisted closure (VAC) device for negative pressure treatment with suction drainage 9, 10 through 2 separate incisions (Figures 1-4).

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Complications of Methylene Blue Dye in Breast Surgery: Case Reports and Review of the Literature

Reyes F, Noelck M, Valentino C, Grasso-Lebeau L, Lang J - J Cancer (2010)

The breast is shown after wound VAC sponge removal and delayed primary closure over drains. Note the volume loss secondary to the MBD skin and breast necrosis.
© Copyright Policy
Figure 4: The breast is shown after wound VAC sponge removal and delayed primary closure over drains. Note the volume loss secondary to the MBD skin and breast necrosis.
Mentions: We subsequently admitted the patient to the hospital to perform an incision and drainage (I&D) of her left breast unresolving abscess cavity. We made an incision in the area of maximal fluctuance in the left breast in the periareolar region at 5 o'clock. To explore the borders of the cavity, we used a lacrimal probe; we noted that the cavity was connected to the sinus in the 8 o'clock position. The cavity measured approximately 8cm x 7cm x 2.5cm and contained necrotic tissue. Then, we made a separate incision over the sinus in the 8 o'clock position and completely excised the tract. Once we debrided the cavity, we placed a wound vacuum-assisted closure (VAC) device for negative pressure treatment with suction drainage 9, 10 through 2 separate incisions (Figures 1-4).

Bottom Line: Introduction: Methylene blue dye has been used worldwide successfully with few complications in breast surgery.She required multiple debridements and had granulomas masquerading as cancer on MRI that confounded her extent of disease.Conclusions: The use of methylene blue dye in breast surgery is not without risk.Methylene blue may cause not only significant morbidity, but may also produce cosmetically unsatisfactory results.

Affiliation: 1. Department of General Surgery, Division of Surgical Oncology, University of Arizona, Tucson, AZ 85724, USA.

ABSTRACT

Background: Introduction: Methylene blue dye has been used worldwide successfully with few complications in breast surgery. We present two different complications involving methylene blue: 1) skin and parenchymal necrosis when dye was injected in a subdermal fashion and 2) Mycoplasma infection caused by contaminated methylene blue in breast reduction surgery.Methods: We present two cases seen at the University of Arizona during 2008 and referred to a breast surgeon for management. We evaluated and managed complications of methylene blue dye injected by 2 referring surgeons for different indications. A review of the literature was performed.Results: The first case is a 67 year old female diagnosed with infiltrating ductal carcinoma of the left breast for which she was treated by her initial surgeon with left segmental mastectomy and sentinel node biopsy. The operating surgeon injected methylene blue in a subareolar subdermal fashion (distant from the primary tumor); unfortunately the patient suffered skin and breast necrosis requiring multiple surgical debridements and finally achieving delayed primary closure. The second case is a 45 year old female with infiltrating lobular carcinoma with a history of Mycoplasma infection secondary to methylene blue injected for breast reduction surgery. She required multiple debridements and had granulomas masquerading as cancer on MRI that confounded her extent of disease.Conclusions: The use of methylene blue dye in breast surgery is not without risk. In both cases methylene blue was responsible for complications requiring surgical debridement for local wound problems. In each case severe necrosis and infection were present. Methylene blue may cause not only significant morbidity, but may also produce cosmetically unsatisfactory results.

View Similar Images In: Results  - Collection
View Article: Pubmed Central -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=3005551&rFormat=json&query=null&req=5