In Vitro Evaluation of Common Antimicrobial Solutions Used for Breast Implant Soaking and Breast Pocket Irrigation—Part 2: Efficacy Against Biofilm-Associated Bacteria

Abstract

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.

In Vitro Evaluation of Common Antimicrobial Solutions Used for Breast Implant Soaking and Breast Pocket Irrigation—Part 1: Efficacy Against Planktonic Bacteria

“…epidermidis showing the most resistance to eradication with at least 2.5% PI required to show maximum log reduction in bacterial survival. Therefore, it appears that for implant soaking and irrigation of primary breast pockets, significant dilution of PI is possible while still maintaining general antimicrobial efficacy at an exposure time of 5 minutes, which is in stark contrast to what was observed in our biofilm-associated bacteria study, 36 where dilution of PI lower than one-eighth to quarter-strength significantly reduced its efficacy at 5 minutes of exposure. Interestingly, our results with 5 minutes of exposure time to diluted PI (refer to Figure 3C ) are similar to those reported by Berkelman and co-workers 37 for efficacy of dilute PI against S .…”

Pharmacological Approaches for the Prevention of Breast Implant Capsular Contracture

“…121,176 A topical application of antibiotics only (e.g., cephalotin, cefazolin, gentamicin and/or bacitracin) halved the risks of infection and seroma but did not significantly modify the risks of CC occurrence. 169,177 These results show that irrigating the pocket with antibiotics and antiseptics is important to reduce the risks of CC but not mandatory.…”

“…Irrigation of the breast implant pocket, and/or the implants themselves, with various sterile or drug solutions is both widely reported and practised as part of efforts to reduce the rate of CC and for mitigating the risk of BIA-ALCL. 117,164,118,[169][170][171][172] Commonly administered solutions include sterile saline, 115,173 a triple antibiotic solutions (such as bacitracin, neomycin and polymyxin b), 115 and triamcinolone acetonide (Table ). 139 The results to date have been mixed.…”

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

“…Given the fact that hitherto the exact cause for capsular contraction has not yet been determined sufficiently, the biofilm hypothesis is one of the major corner stones to explain fibroblast proliferation. Chronic inflammation is somehow considered to play a role in this entity and hence numerous authors have tried to circumvent biofilm occurrence utilizing various disinfectants or antibiotic solutions, applied directly to implants, and into the implant pockets ( Dang et al, 2020 ; Jewell et al, 2021 ; Nai et al, 2021 ).…”