Bilateral breast infection following total breast reconstruction with autologous fat transfer (AFT): A case report.

INTRODUCTION AND IMPORTANCE: Total breast reconstruction with autologous fat transfer (AFT) has a low complication rate. Fat necrosis, infection, skin necrosis and hematoma are the most common complications. Infections are usually mild and manifested by a unilateral red painful breast and treated with oral antibiotics with or without superficial irrigation of the wound. CASE PRESENTATION: One of our patients reported an ill-fitting pre-expansion device several days after surgery. This was due to a severe bilateral breast infection following a session of total breast reconstruction with AFT despite perioperative and postoperative antibiotic prophylaxis. Surgical evacuation was performed in combination with both systemic and oral antibiotic treatment. CLINICAL DISCUSSION: Most infections can be prevented in the early post-operative period with antibiotic prophylaxis. If an infection does occur, it is treated with antibiotics or superficial irrigation of the wound. A delay in identification of an alarming course could be reduced by monitoring the fit to the EVEBRA device, implementing video consultations on indication, limiting the means of communication and better informing the patient on what complications to monitor. The recognition of an alarming course following a subsequent session of AFT is not guaranteed after a session without complication. CONCLUSION: Besides temperature and redness of the breast, a pre-expansion device that doesn't fit can be an alarming sign. Patient communication should be adapted as severe infections can be insufficiently recognized by phone. Evacuation should be considered when an infection does occur.

The Death of Freddie Gray and Its Impact on Homicides in Baltimore and Maryland.

This study evaluated the impact that Freddie Gray's death on April, 19, 2015, had on homicides within Baltimore, Prince George's County, and the rest of Maryland. The numbers of these deaths were compared in the 2 years prior and after his death. The average number of homicide per month in Baltimore and Prince George's County, but not the rest of Maryland, showed a statistically significant increase in the 2 years after his death, with a sudden spike in homicides in Baltimore immediately following his death. Spatial density ("heat") maps of homicides showed an increase in clustering of deaths after Freddie Gray's demise in portions of Baltimore, particularly near his arrest site. Hot spot maps showed a massive expansion of statistically significant clusters of homicides in areas of West and East Baltimore after his death. An emerging hot spot analysis revealed consecutive hot spots in large areas of West Baltimore with new hot spots prominent along the southern edge of this area. A review of the history of Baltimore, as well as discussions with Baltimore homicide detectives, revealed that prior socioeconomic and political trends likely primed Baltimore for the protests and violence that occurred after Freddie Gray's death. It is probable that a perceived "overcharging" of officers involved in his death by the State's Attorney resulted in a "pullback" from policing that directly led to increased homicides in Baltimore.