Why do I break out after extractions sometimes but not others?

That comes down to two things and one of them you will need to time with the calendar.

That first thing is the cleanliness of the skin. For the same reason your doctor swabs your arm with alcohol before drawing blood, you need to clean your face before you do any sort of deep pore cleansing. We have a lot of bacteria on our skin besides p. acne that can lead to blemishes. While we cant eliminate all bacteria. Washing drastically reduces the quantity of bacteria. Down to numbers that are not going to set off our inflammatory response.

The second reason would be the timing of your menstrual cycle. There is a window of time when a woman can do extractions and be in the clear. And another window when further breakouts are almost guaranteed no matter how well you cleanse first.

The time to suspend any and all extraction activities starts about a week before your period begins and stops about 4 days after bleeding has subsided. The reason for the almost guaranteed breakouts during this time is the surge of prostaglandins in the bloodstream. These are chemical messengers that tell your immune system where it needs to create an inflammatory response. Unfortunately, they find their way out of the uterus and into the bloodstream where they travel throughout your body finding other areas where they think an inflammatory response should be deployed. Like small bacterial colonies on the face. They are the same culprit for why people with inflammatory disorders see an uptick in symptoms during their menstrual cycle.