Preventing Breast Implant Contamination in Breast Reconstruction: A National Survey of Current Practice

Arvind U. Gowda, Karan Chopra, Emile N. Brown, Sheri Slezak, Yvonne Rasko

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Implant-based breast reconstruction is commonly performed by plastic surgeons worldwide. Bacterial contamination is of paramount concern because of its role in biofilm formation and capsular contracture. Plastic surgeons have adopted a variety of perioperative interventions in efforts to reduce implant contamination; however, definitive evidence supporting these practices is lacking. OBJECTIVE: The goal of this study was to assess current practice patterns aimed at reducing implant-related infections. METHODS: A 20-question survey assessing practices aimed at preventing breast implant–associated infections was generated and distributed via SurveyMonkey to members of the American Society of Plastic Surgery whose e-mail addresses were listed on the American Society of Plastic Surgery member Web site in April 2015. RESULTS: A total of 1979 invitations to participate in the survey were sent, and 253 responses were received during the 4-month study period. Of respondents, 81% were in private practice. Respondents averaged 21 ± 9 years in practice, and 34 ± 50 implant-based breast reconstructions were performed per year. A majority of surgeons used chlorhexidine to prepare the surgical site (52%), a triple antibiotic soak for the implant prior to placement (50%) and povidone-iodine for implant pocket irrigation (44%). A no-touch technique utilizing the Keller funnel was adopted by 69% of surgeons. Regarding antibiotic use in the postoperative period, first-generation cephalosporins (eg, cephalexin, cefadroxil) were used by a majority of surgeons (84%), and the most common duration was until drain removal (45%). CONCLUSIONS: There is considerable heterogeneity in surgical practices aimed at preventing bacterial contamination in implant-based breast reconstruction. Surgeons may benefit from high-level studies designed to create standardized evidence-based practice guidelines.

Original languageEnglish (US)
JournalAnnals of Plastic Surgery
DOIs
StateAccepted/In press - Jul 26 2016

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Breast Implants
Mammaplasty
Plastic Surgery
Cefadroxil
Anti-Bacterial Agents
Cephalexin
Povidone-Iodine
Chlorhexidine
Evidence-Based Practice
Private Practice
Touch
Postal Service
Contracture
Cephalosporins
Biofilms
Infection
Practice Guidelines
Postoperative Period
Surveys and Questionnaires
Surgeons

ASJC Scopus subject areas

  • Surgery

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Preventing Breast Implant Contamination in Breast Reconstruction : A National Survey of Current Practice. / Gowda, Arvind U.; Chopra, Karan; Brown, Emile N.; Slezak, Sheri; Rasko, Yvonne.

In: Annals of Plastic Surgery, 26.07.2016.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Implant-based breast reconstruction is commonly performed by plastic surgeons worldwide. Bacterial contamination is of paramount concern because of its role in biofilm formation and capsular contracture. Plastic surgeons have adopted a variety of perioperative interventions in efforts to reduce implant contamination; however, definitive evidence supporting these practices is lacking. OBJECTIVE: The goal of this study was to assess current practice patterns aimed at reducing implant-related infections. METHODS: A 20-question survey assessing practices aimed at preventing breast implant–associated infections was generated and distributed via SurveyMonkey to members of the American Society of Plastic Surgery whose e-mail addresses were listed on the American Society of Plastic Surgery member Web site in April 2015. RESULTS: A total of 1979 invitations to participate in the survey were sent, and 253 responses were received during the 4-month study period. Of respondents, 81{\%} were in private practice. Respondents averaged 21 ± 9 years in practice, and 34 ± 50 implant-based breast reconstructions were performed per year. A majority of surgeons used chlorhexidine to prepare the surgical site (52{\%}), a triple antibiotic soak for the implant prior to placement (50{\%}) and povidone-iodine for implant pocket irrigation (44{\%}). A no-touch technique utilizing the Keller funnel was adopted by 69{\%} of surgeons. Regarding antibiotic use in the postoperative period, first-generation cephalosporins (eg, cephalexin, cefadroxil) were used by a majority of surgeons (84{\%}), and the most common duration was until drain removal (45{\%}). CONCLUSIONS: There is considerable heterogeneity in surgical practices aimed at preventing bacterial contamination in implant-based breast reconstruction. Surgeons may benefit from high-level studies designed to create standardized evidence-based practice guidelines.",
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