Antimicrobial Irrigation and Technique during Breast Augmentation: Survey of Current Practice

Epps, Mathew T.; Langsdon, Sarah; Pels, Taylor K.; Lee, Tara M.; Thurston, Todd E.; Brzezienski, Mark A.

doi:10.1097/gox.0000000000002310

Cited by 14 publications

(13 citation statements)

References 37 publications

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“…Irrigation with triple antibiotics has become the standard of care; however, a survey of American Society of Plastic Surgery (ASPS) surgeons in 2018 found a lack of consensus with over 30 irrigation solution combinations in use [ 6 ]. Triple-antibiotic solution without povidone-iodine was favored by over 40% of members, with an additional 17% using triple-antibiotic solution with povidone-iodine [ 6 ]. Other surgeons use differing numbers of antibiotics or singularly dilute povidone-iodine solution [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Adams et al explored the clinical efficacy of antibiotic irrigations, and their recommendation of a triple-antibiotic solution comprised of a cephalosporin, bacitracin, and gentamycin became the gold standard for intraoperative infection prevention in breast implant cases [ 4 ]. Even so, a consensus on optimal antibiotics to include has not been reached, and a variety of combinations is used among plastic surgeons in the United States [ 6 ]. The off-label use of povidone-iodine, an antiseptic, in irrigation has also been inconsistent [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Even so, a consensus on optimal antibiotics to include has not been reached, and a variety of combinations is used among plastic surgeons in the United States [ 6 ]. The off-label use of povidone-iodine, an antiseptic, in irrigation has also been inconsistent [ 6 ]. Prior to 2000, povidone-iodine was commonly implemented as an irrigation material for breast implants; however, a moratorium on its use in irrigation was enacted by the US Food and Drug Administration (FDA) over concerns about silicone implant degradation [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Prior to 2000, povidone-iodine was commonly implemented as an irrigation material for breast implants; however, a moratorium on its use in irrigation was enacted by the US Food and Drug Administration (FDA) over concerns about silicone implant degradation [ 7 ]. Since its return to the market in 2017, it has been reintroduced to irrigation solutions by many plastic surgeons [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Bacitracin for Injection Recall: Impact on Immediate Breast Implant Surgical Outcomes

et al. 2022

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Background. Triple-antibiotic irrigation of breast implant pockets is a mainstay of infection prophylaxis in breast reconstruction and augmentation. The recall of bacitracin for injection due to risk of anaphylaxis and nephrotoxicity in January 2020, a staple component of the irrigation solution, has raised concern for worsened postoperative sequelae. This study aimed to investigate pre- and post-recall implant-based breast surgery to analyze the impact of bacitracin in irrigation solutions on infection rates. Methods. All implant-based breast reconstruction or augmentation surgeries from January 2019 to February 2021 were retrospectively reviewed. In a regression discontinuity study design, patients were divided into pre- and post-recall groups. Patient demographics, surgical details, and outcomes including infection rates were collected. Differences in complication rates were compared between groups and with surgical and patient factors. Results. 254 implants in 143 patients met inclusion criteria for this study, with 172 implants placed before recall and 82 placed after recall. Patients in each cohort did not differ in age, BMI, smoking status, or history of breast radiation or capsular contracture ( p > 0.05 ). All breast pockets were irrigated with antibiotic solution, most commonly bacitracin, cefazolin, gentamycin, and povidone-iodine before recall (116,67.4%) and cefazolin, gentamycin, and povidone-iodine after recall (59,72.0%). There was no difference in incidence of infection (6.4% vs. 8.5%, p = 0.551 ) or cellulitis (3.5% vs. 3.7%, p = 0.959 ) before and after recall. Implant infection was associated with smoking history ( p < 0.001 ) and increased surgical time ( p = 0.003 ). Conclusions. Despite the recent recall of bacitracin from inclusion in breast pocket irrigation solutions, our study demonstrated no detrimental impact on immediate complication rates. This shift in irrigation protocols calls for additional investigations into optimizing antibiotic combinations in solution, as bacitracin is no longer a viable option, to improve surgical outcomes and long-term benefits.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bacitracin for Injection Recall: Impact on Immediate Breast Implant Surgical Outcomes

et al. 2022

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“…The most commonly used antibiotic irrigation solution is triple antibiotic solution (TAS). 20 However, recent studies have shown efficacy of other antiseptic solutions such as hypochlorous acid and povidone-iodine. 21 , 22 Currently, there is no current consensus on breast implant pocket irrigation.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Breast Reconstruction Outcomes Using Oxychlorosene versus Triple Antibiotic Solution for Pocket Irrigation

Bamba

Tran

Mailey

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Breast pocket irrigation with antiseptic solutions is performed to reduce contamination with breast implants. The optimal antiseptic irrigation solution and the efficacy of individual practices are unclear. Oxychlorosene sodium is frequently used at our institution. Oxychlorosene is bactericidal with a mechanism of action of oxidation and hypochlorination. The purpose of our study was to compare the outcomes of oxychlorosene sodium irrigation with triple antibiotic solution (TAS) in implant-based breast reconstruction. Methods: All patients who underwent implant-based reconstruction after mastectomy were reviewed. The primary predictive variable was type of solution used for pocket irrigation (TAS or oxychlorosene). Outcome variables included surgical site infection, device removal, and wound complications. Results: Between 2013 and 2018, 331 implant-based breast reconstructions were performed. Of these, 62% (n = 206) received oxychlorosene for surgical pocket irrigation (group I), and 38% (n = 125) received TAS (group II). Group I had an 11.7% (n = 24) 90-day surgical site infection rate, with 4.9% (n = 10) requiring oral antibiotics, 2.4% (n = 5) requiring intravenous antibiotics without device removal, and 4.4% (n = 9) requiring prosthetic removal. Group II had an 11.2% (n = 14) 90-day infection rate, with 5.6% (n = 7) requiring oral antibiotics, 2.4% (n = 3) requiring intravenous antibiotics without device removal, and 3.2% (n = 4) requiring removal (P = 0.90). When comparing the cost of oxychlorosene irrigation with TAS irrigation, oxychlorosene was less expensive. Conclusions: Oxychlorosene and TAS have similar surgical site infection rates in prosthetic breast reconstruction. Ease of preparation and cost make oxychlorosene a more favorable option for antibiotic irrigation in reconstructive breast surgery with prosthetic devices.

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Use of Antimicrobial Irrigation and Incidence of Capsular Contracture in Breast Augmentation and Immediate Implant-Based Breast Reconstruction

Federica,

Tommaso,

Alessia

et al. 2023

Aesth Plast Surg

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Capsular contracture (CC) is one of the most common complications of implant-based breast reconstruction or augmentation surgery. Common risk factors of CC include biofilm, surgical site infections, history of prior CC or fibrosis, history of radiation therapy, and implant characteristics. Though bacterial contamination of breast protheses is associated with adverse sequelae, there are not universally accepted guidelines and limited best practice recommendations for antimicrobial breast pocket irrigation. Despite advanced molecular biology, the exact mechanism of this complication is not fully understood. Interventions that decrease the rate of CC include antibiotic prophylaxis or irrigation, acellular dermal matrix, leukotriene inhibitors, surgical techniques, and others. However, there is inconsistent evidence supporting these risk factors, and the current data was based on broad heterogeneous studies. The objective of this review was to provide a summary of the current data of contributing risk factors as well as preventative and treatment measures for CC.Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266

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Antimicrobial Irrigation and Technique during Breast Augmentation: Survey of Current Practice

Abstract: Supplemental Digital Content is available in the text.

Cited by 14 publications

References 37 publications

Bacitracin for Injection Recall: Impact on Immediate Breast Implant Surgical Outcomes

Bacitracin for Injection Recall: Impact on Immediate Breast Implant Surgical Outcomes

Comparison of Breast Reconstruction Outcomes Using Oxychlorosene versus Triple Antibiotic Solution for Pocket Irrigation

Use of Antimicrobial Irrigation and Incidence of Capsular Contracture in Breast Augmentation and Immediate Implant-Based Breast Reconstruction

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