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

Abstract

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.

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

“…Treatment with PI can also elicit cytotoxic effects on healthy cells 27-30 and, as such, some clinicians dilute PI to avoid these effects while mitigating bioburden. However, as noted in our results and in contrast to the results of our planktonic bacteria study, 45 diluting PI lower than quarter-strength will likely minimize its efficacy against biofilm-associated bacteria.…”

“…epidermidis may be the most tolerant species to PI, which is consistent with the results of our study with planktonic bacteria. 45 …”

“…The neutralizer was then aspirated, and fresh solution of D/E added to the wells. Note that in this assay, the majority of the treatment is removed through aspiration, allowing for TAB to be evaluated and appropriately neutralized, unlike the planktonic assay previously reported, 45 which required a 24-well plate setup to allow for proper neutralization of the TAB treatment (ie, 400× dilution). Viable bacteria were recovered through indirect sonication, wherein the 96-well plate was placed on a water bath sonicator equipped with a metal lid.…”

“…This report serves as part 2 of a series of companion publications in which the first part focuses on planktonic bacteria with relevance to primary breast surgeries and contamination of breast implant or tissue expander surfaces. 45 The current manuscript discusses treatment parameters to address potential infections presented during revision surgeries and tissue expander-breast implant exchange surgeries where a mature capsule has formed prior to placement of the new breast implant and biofilm-associated bacteria may be present.…”

Current Concepts in Capsular Contracture: Pathophysiology, Prevention, and Management

“…57 However, newer in vitro studies have found that povidone-iodine only or povidone-iodine containing triple-antibiotic solutions are more effective at significantly decreasing planktonic species and biofilm production. 60,61 In addition to irrigating the breast implant pocket, these solutions can also be injected into the implant packaging to address potential bacterial attraction due to an electrostatic charge imparted on opening the sterile package. 35 Layered closure of the incision must be performed to prevent implant exposure or inadvertent contamination.…”