Efficacy of Povidone Iodine Against Microbial Biofilms in Breast Implants With Different Textures: Results From an in vitro Study

Abstract

BackgroundIn the practice of breast augmentation and reconstruction, implant irrigation with various solutions has been widely used to prevent infection and capsular contracture, but to date, there is no consensus on the optimal protocol to use. Recently, application of povidone iodine (PI) for 30 min has shown in vitro to be the most effective irrigating formula in reducing contamination in smooth breast implants. However, as 30 min is not feasible intraoperatively, it is necessary to determine whether shorter times could be equally effective as well as to test it in both smooth and textured implants.MethodsWe tested the efficacy of 10% PI at 1′, 3′, and 5′ against biofilms of 8 strains (2 ATCC and 6 clinical) of Staphylococcus spp. on silicone disks obtained from Mentor® and Polytech® implants of different textures. We analyzed the percentage reduction of cfu counts, cell viability and bacterial density between treatment (PI) and control (sterile saline, SS) groups for each time of application. We consider clinical significance when > 25% reduction was observed in cell viability or bacterial density.ResultsAll textured implants treated with PI at any of the 3 exposure times reduced 100% bacterial load by culture. However, none of the implants reached enough clinical significance in percentage reduction of living cells. Regarding bacterial density, only 25–50 μm Polytxt® Polytech® implants showed significant reduction at the three PI exposure times.ConclusionPI is able to inhibit bacterial growth applied on the surface of breast implants regardless of the exposure time. However, no significant reduction on living cells or bacterial density was observed. This lack of correlation may be caused by differences in texture that directly affect PI absorption.

Gram-positive bacteria increase breast implant related complications: Prospective analysis of 100 revised implants.

“…20,21 The implant's surface itself is also of significance in local contamination and ingrowth of bacteria. 12,22 The uneven surface of textured implants offers more possibilities for pathogens to settle and evade the immune system, despite meticulous antisepsis, therefore possibly resulting in an increase of unnoticed implant contamination and subclinical infection rates leading to implant damage. Similar effects have been documented in the pathogenesis of BIA-ALCL.…”

Management of Biofilm with Breast Implant Surgery

“…114 The pretreatment of smooth or textured breast implant surfaces with 10% PI for as little as 1 minute in vitro can prevent growth of S. epidermidis or S. aureus applied to the device surface but does not significantly affect bacterial load or living cells. 115…”

The Current Knowledge on the Pathogenesis of Tissue and Medical Device-Related Biofilm Infections

“…In breast surgery with implants, infection of the surgical site as a consequence of bacterial colonization of the implant is one of the most relevant complications [ 87 ]. The presence of bacterial biofilm has been correlated with the development of capsular contracture, which is the most frequent complication in breast implant surgery reported in 5.2% to 30% of patients with breast implants [ 59 , 88 ].…”

“…One of the most recent studies regarding preventive measures during breast surgery demonstrated that povidone–iodine used for implant irrigation was the best antiseptic capable of eradicating biofilm [ 87 , 90 ]. However, povidone–iodine absorption may be directly related to implant texture rather than to exposure time [ 87 ].…”

“…One of the most recent studies regarding preventive measures during breast surgery demonstrated that povidone–iodine used for implant irrigation was the best antiseptic capable of eradicating biofilm [ 87 , 90 ]. However, povidone–iodine absorption may be directly related to implant texture rather than to exposure time [ 87 ]. Moreover, Barnea et al demonstrated that pre-treating implants with plasma before immersion in the povidone–iodine solution for only 5 s significantly improved its absorption [ 91 ].…”