Infection following Leech Therapy for the Treatment of Nipple-Areola Complex Congestion after Breast Reduction: A Case Report
Torresetti M, Peltristo B, Taddei FMJ, Di Benedetto G (2024) · Archives of Plastic Surgery · n=1
Study Profile
- Design
- single-patient case report of breast infection and sepsis following leech therapy for nipple-areola complex (NAC) venous congestion after reduction mammaplasty (Clinic of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, Ancona, Italy)
- Sample size (n)
- 1
- Intervention
- Description of an Italian female patient who underwent reduction mammaplasty followed by leech therapy for NAC venous congestion and subsequently developed wound infection and sepsis; management included prompt surgical debridement, necrotic-tissue excision, and targeted antibiotic therapy
- Comparator
- Not applicable - single-patient safety case report; within-subject pre/post timeline
- Primary endpoint
- Clinical recognition and management of soft-tissue infection following leech therapy in breast surgery; preservation of partial NAC viability after debridement and targeted antibiotics
- Primary result
- Patient developed breast infection and sepsis after leech therapy for NAC congestion; prompt surgical debridement and targeted antibiotic therapy led to rapid clinical improvement; partial NAC preservation was achieved; authors emphasize that early diagnosis is critical and serves as a warning for surgeons performing breast cosmetic procedures
- Follow-up duration
- until infection resolution and partial NAC viability confirmation
- PMID
- 38737840
Key Findings
- Documents serious infection and sepsis as adverse outcome of leech therapy for NAC congestion after breast reduction
- Demonstrates that even prompt surgical debridement plus antibiotic therapy may not fully preserve NAC viability
- Italian case adds southern European safety surveillance to the breast-flap leech evidence base
- Reinforces clinical importance of early infection recognition in patients receiving leech therapy
- Provides important counterweight to optimistic breast-flap leech case reports (e.g., Freeman 2015, Moffat 2015)
Limitations
- Single case (n=1) - cannot establish incidence rate
- Selection bias - case reports tend to over-represent serious adverse events
- Antibiotic prophylaxis regimen details not specified in abstract
- Long-term outcomes beyond initial infection resolution not reported
- Causality attribution to leech therapy versus surgical context complicated
Clinical Implications
Torresetti 2024 is an important contemporary case report documenting that leech therapy in breast surgery carries real infection risk that can progress to sepsis even in academic European centers. For US clinicians, the case strongly supports rigorous antibiotic prophylaxis, infection surveillance, and patient counseling. The case should be cited alongside Freeman 2015 and Moffat 2015 in any educational discussion of breast-flap leech therapy to give patients and clinicians a balanced understanding of both efficacy and risk. The trial complements the antibiotic-stewardship concerns documented by Beka 2018, Wilmer 2013, and Reese 2015 in framing the safety dimension of leech therapy in breast surgery.
Related Trials
Leech (Hirudo medicinalis) Therapy for the Treatment of Nipple-Areolar Complex Congestion Following Breast Reduction
Freeman M, Carney M, Matatov T, Vemula R, Babycos C (2015)
Compromised breast flap treated with leech therapy, hyperbaric oxygen, pentoxifylline and topical nitroglycerin: A case report
Moffat AD, Weaver LK, Tettelbach WH (2015)
The Use of Medicinal Leeching in Breast Surgery: A Systematic Review
Rajaram R, Cevik J, Bhindi N, Seth I, Rozen WM (2024)
Early venous congestion after DIEP flap breast reconstruction: case report of a successful management
Baccarani A, Starnoni M, Pappalardo M, Lattanzi M, Blessent CGF, De Maria F, De Santis G (2022)