Background Biofilm-associated bacteria have been observed in both breast implant revision and tissue expander-implant exchange surgeries. The utilization of antimicrobial solutions in breast surgery, especially those containing triple antibiotics (TAB) and/or 10% povidone-iodine (PI), may help reduce existing biofilm-associated bacteria, which is particularly important in a mature breast pocket that may contain residual bacteria from a previously colonized implant surface or, theoretically, bacteria that may arrive postoperatively through hematogenous spread. Objectives A series of in vitro assessments was performed to evaluate the antimicrobial utility of TAB and PI, either alone or in combination, against preformed biofilm-associated bacteria. Methods Preformed biofilm-associated gram-positive and gram-negative bacterial strains were exposed to TAB and PI ± TAB for up to 30 minutes in a bacterial time-kill assay. Efficacy of various dilutions of PI and the effects of serum protein on PI efficacy were also investigated. Results TAB was ineffective at the timeframes tested when utilized alone; when utilized in conjunction with PI, significant log reduction of all biofilm-associated bacterial species tested was achieved when treated for at least 5 minutes. PI alone at a concentration of 25% or higher was also effective, although its efficacy was negatively affected by increasing serum protein concentration only for Staphylococcus epidermidis. Conclusions Our data indicate that PI-containing solutions significantly reduce biofilm-associated bacteria, suggesting potential utility for breast pocket irrigation during revision or exchange surgeries. Care should be taken to minimize excessive dilution of PI to maintain efficacy.

Background Planktonic bacteria can be inadvertently introduced during breast surgery procedures, which are hypothesized to lead to complications such as infection, capsular contracture, BIA-ALCL, and a prolonged local inflammatory response. The use of antimicrobial solutions such as triple antibiotic solution (TAB) and/or 10% povidone-iodine (PI), in breast pocket irrigation or implant soaking have been proposed to reduce planktonic bacterial attachment and potential complications. Objectives A series of in vitro assessments were performed to evaluate the antimicrobial utility of triple antibiotic solution (TAB) and PI, either alone or in combination, against planktonic bacteria. Methods Planktonic gram-positive and gram-negative bacterial strains were exposed to TAB and PI +/- TAB for up to 10 minutes in a bacterial time-kill assay. Efficacy of various dilutions of PI as well as the effects of serum protein on PI efficacy were also investigated. Results TAB was ineffective at the timeframes tested (≤ 10 minutes) when used alone; however, when used with PI, significant log reduction of all tested planktonic species was achieved. PI alone was also effective, even including dilute concentrations (e.g., 0.5% PI), although the presence of serum proteins required higher concentrations of PI (e.g., 2.5%) to eradicate the bacterial load. Conclusions Our data suggest PI-containing solutions may be preferred over either saline or TAB without PI for primary breast pocket irrigation and implant soaking in primary breast surgeries as a means to significantly reduce planktonic bacteria. These data provide an impetus for surgeons to re-evaluate the efficacy of TAB solution in these clinical settings.