Breast infection after nipple piercing in augmented breasts: a case report and review of literature

Breast augmentation is among the most frequently performed aesthetic procedures worldwide. Although postoperative infections are uncommon, breast implant-associated infections can be severe and challenging to treat. Nipple piercings, increasingly popular among young women, are a recognized source of local infection, yet their implications in patients with implants remains poorly characterized. This report describes a case of breast infection following nipple piercing in a woman with breast implants and to review the relevant literature. A 23-year-old woman with a history of subpectoral breast augmentation underwent bilateral nipple piercing and subsequently developed rapidly progressive left breast pain, erythema and purulent drainage. Ultrasound revealed a multiloculated abscess. Aspiration cultures grew Streptococcus pyogenes, while intraoperative cultures from both implant pockets were sterile. Despite the absence of direct pocket involvement, her clinical deterioration warranted urgent abscess drainage and bilateral explantation, after which she recovered fully on antibiotic therapy. A targeted literature review identified four published cases of breast or chest implant infections associated with nipple piercing. Reported infections occurred 2–50 weeks after piercing and most involved Staphylococcus or Streptococcus species. Management ranged from antibiotics alone to explantation, though follow-up in most reports was limited. Breast infections following nipple piercing in augmented patients are rare but potentially severe. Significant soft-tissue infections may necessitate explantation, even when pockets appear uninvolved. Patients considering nipple piercing after augmentation should be counseled about these risks, and further systematic reporting is needed to guide prevention and treatment strategies.