Detailed Patient demographics and the type of reaction and treatment are listed in Table 1.Persons Aged 6 Months – 5 Years Local Reactions Microbiology did not grow any pathogen from the taped implant pocket. The further postoperative course was uneventful and the patient was discharged a few days later. Puncture revealed pus in the implant pocket and we therefore removed the implant and performed a thorough washout and an immediate reconstruction with a free transverse myocutaneous gracilis flap from the contralateral thigh. After symptoms worsened in the following days under initial treatment with an oral antibiotic an ultrasound revealed seroma which was not present in earlier postoperative scans. The patient was immunized with the AstraZeneca vaccine one day prior to her presentation to our department. Our most recent and fourth patient presented with sudden exaggerating pain and signs of a fulminant infection in her right breast after implant reconstruction eight weeks earlier. Again, conservative therapy including oral tramadol due to high level of pain was started and all symptoms resolved during the next days. On examination there were no signs of any inflammation, capsular fibrosis or other remarkable findings. Her last expander filling was four weeks earlier. Our third patient presented with onset of excruciating pain in her right breast where she had an expander placement in preparation of a later implant based reconstruction after receiving an immunization with the Johnson and Johnson's Janssen vaccine three days earlier. Again these symptoms resolved spontaneously shortly after they occurred with conservative therapy Fig. 2. A second patient had a bilateral breast augmentation with implants 17 months prior and presented with the same symptoms and sudden onset of pain bilaterally just two days after receiving the Pfizer/Biontec vaccine Fig. 1. All symptoms resolved spontaneously two days after onset under local treatment with an oral NSAID and cryotherapy. Our first patient had a cosmetic breast augmentation five years earlier and presented with sudden onset of pain and discomfort resembling symptoms of bilateral capsular fibrosis two days after receiving the Pfizer/Biontec vaccine. Nevertheless we feel the urge to release these information at the earliest to educate colleagues and draw attention to possible reactions between the COVID-19 vaccines and foreign bodies such as breast implants. We are aware that these potential side effects after the immunizations that we discuss here are subjective observations of very unlikely events. We believe it is relevant to share these observations and raise awareness of potential and not well understood reactions of the immune system to breast implants after COVID-19 immunizations. In the recent weeks we observed four noteworthy potential reactions in association with breast implants between one and three days after COVID-19 vaccinations. Therefore any other implant, such as a breast implant or an artificial joint may also be subject to an inflammatory response after different types of vaccinations. In theory, likewise to dermal fillers any foreign material may cause a reaction when our immune system is triggered as consequence of the normal elevated immune response. Similar reactions were observed after immunizations with influenza vaccines in the past. Interestingly the time of facial hyaluronic acid treatment was somewhat between two weeks and up to two years before the immunization with a COVID-19 vaccine. Symptoms of an immune response to the foreign material were recorded between one and two days after the vaccination during the Moderna phase three trial and were independent from the time of the cosmetic injectable treatment. These Filler reactions presented as soft tissue swelling and facial edema shortly after the first and/or second dose with the Moderna vaccine. Besides these alarming potential side effects there have been rare observations of rather benign reactions to foreign materials such as cosmetic hyaluronic acid filler injections after a COVID-19 immunization. Reports of lethal cavernous sinus thrombosis and pulmonal artery embolism after vaccination with the COVID-19 vaccines represent a major concern for patients and doctors. COVID-19 vaccination associated complications and side effects have widely gained public attention and media coverage recently.
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