Aniketh Venkataram1, Nicholas Lahar2, William P Adams3. 1. Consultant plastic surgeon in private practice in Vijaynagar Bangalore, India. 2. Clinical Instructor, UCLA, Beverly Hills, CA. 3. Associate professor, Department of Plastic Surgery, UT Southwestern, Dallas, TX; and is a clinical editor for Aesthetic Surgery Journal and ASJ Open Forum.
Abstract
BACKGROUND: Capsular contracture (CC) remains the most common complication of implant based aesthetic and reconstructive breast surgery. With subclinical infection being proven to be the primary etiology, antimicrobial breast pocket irrigation has been recommended as the key step to reduce this complication. Despite the data of well proven of anti-microbial breast pocket irrigations, there exists a lack of universal adoption. OBJECTIVES: The purpose of this study is to perform a review of CC rates using previously described and proven anti-microbial breast pocket irrigations. METHODS: Data from patients undergoing cosmetic breast augmentation were recorded prospectively from 1997-2017. The irrigation solutions used was either the betadine containing (50% betadine or "betadine triple") or non-betadine triple antibiotic regimen. The database was assessed to determine the type of implant used, the incidence of CC, and possible contributing factors. The degree of CC was recorded as per Baker classification. RESULTS: A 20 year prospective data collection yielded 2088 patients with 4176 implants. 826 patients had textured implants and 1262 patients had smooth implants. The rate of grade III/IV CC was found to be 0.57% in all patients undergoing primary breast augmentation. The incidence was found to be 1.21% in textured implants and 0.16% in smooth implants. CONCLUSIONS: This study constitutes the largest and longest review of CC in a controlled, single surgeon setting. The low incidence of CC is low and reinforces the efficacy/utility of anti-microbial breast pocket irrigation. Both the betadine and non-betadine antibiotic regimens were found to be effective, with our preference being the betadine regimen. Universal adoption of betadine containing anti-microbial breast pocket irrigation is recommended to reduce CC and other device-associated infection.
BACKGROUND: Capsular contracture (CC) remains the most common complication of implant based aesthetic and reconstructive breast surgery. With subclinical infection being proven to be the primary etiology, antimicrobial breast pocket irrigation has been recommended as the key step to reduce this complication. Despite the data of well proven of anti-microbial breast pocket irrigations, there exists a lack of universal adoption. OBJECTIVES: The purpose of this study is to perform a review of CC rates using previously described and proven anti-microbial breast pocket irrigations. METHODS: Data from patients undergoing cosmetic breast augmentation were recorded prospectively from 1997-2017. The irrigation solutions used was either the betadine containing (50% betadine or "betadine triple") or non-betadine triple antibiotic regimen. The database was assessed to determine the type of implant used, the incidence of CC, and possible contributing factors. The degree of CC was recorded as per Baker classification. RESULTS: A 20 year prospective data collection yielded 2088 patients with 4176 implants. 826 patients had textured implants and 1262 patients had smooth implants. The rate of grade III/IV CC was found to be 0.57% in all patients undergoing primary breast augmentation. The incidence was found to be 1.21% in textured implants and 0.16% in smooth implants. CONCLUSIONS: This study constitutes the largest and longest review of CC in a controlled, single surgeon setting. The low incidence of CC is low and reinforces the efficacy/utility of anti-microbial breast pocket irrigation. Both the betadine and non-betadine antibiotic regimens were found to be effective, with our preference being the betadine regimen. Universal adoption of betadine containing anti-microbial breast pocket irrigation is recommended to reduce CC and other device-associated infection.