Nipple shields and antibiotic prophylaxis in skin and nipple sparing risk reducing mastectomies—a multi-centre study

Original Paper
  • 47 Downloads

Abstract

Background

Florid and sub-clinical infection in implant-based breast reconstruction can cause significant problems. There are a wide and varied range of methods utilised in an attempt to reduce infection. Nipple shields are well known to reduce the spread of infection during surgery as are prophylactic antibiotics.

Methods

Twenty patients, in two centres, had microbiological swabs taken from the nipple-areolar complex after preparation with povidone-iodine and post-operatively from the underside of nipple shields. These swabs were cultured in the local microbiology laboratory.

Results

No swabs after preparation grew organisms. Five (12.5%) swabs taken post-operatively were positive. Of these, three grew coagulase-negative Staphylococcus and two grew mixed skin commensals. All were sensitive to Flucloxacillin.

Conclusions

Nipple shields are essential to reduce the risk of infection. Povidone-iodine is satisfactory for preparation in our cohort. Prophylactic antibiotics are indicated on induction.

Level of Evidence: Level III, risk/prognostic study.

Keywords

Implants Breast reconstruction Nipple shields Antibiotics 

Notes

Compliance with ethical standards

Funding

We received no source of funding.

Conflict of interest

James Wokes, K. Allison, N. Collis declare that they have no conflict of interest.

Ethical approval

No formal ethical approval was sought but the World Medical Association's Declaration of Helsinki principles were followed.

Informed consent

Written informed consent was given by each participant for participation in the study and a written leaflet was provided with information as to the purpose of the study.

References

  1. 1.
    Spear SL, Howard MA, Boehmler JH, Ducic I, Low M, Abbruzzesse MR (2004) The infected or exposed breast implant: management and treatment strategies. Plast Reconstr Surg 113(6):1634–1644CrossRefPubMedGoogle Scholar
  2. 2.
    Schierholz JM, Beuth J (2001) Implant infections: a haven for opportunistic bacteria. J Hosp Infect 49(2):87–93CrossRefPubMedGoogle Scholar
  3. 3.
    Tamboto H, Vickery K, Deva AK (2010) Subclinical (biofilm) infection causes capsular contracture in a porcine model following augmentation mammaplasty. Plast Reconstr Surg 126(3):835–842CrossRefPubMedGoogle Scholar
  4. 4.
    Barr SP, Topps AR, Barnes NL et al (2016) Northwest Breast Surgical Research Collaborative. Infection prevention in breast implant surgery—a review of the surgical evidence, guidelines and a checklist. Eur J Surg Oncol 42(5):591–603Google Scholar
  5. 5.
    Collis N, Mirza S, Stanley PRW, Campbell L, Sharpe DT (1999) Reduction of potential contamination of breast implants by the use of ‘nipple shields’. Br J Plast Surg 52:445–447CrossRefPubMedGoogle Scholar
  6. 6.
    Adams WP Jr, Small KH (2015) The process of breast augmentation with special focus on patient education, patient selection and implant selection. Clin Plast Surg 42(4):413–426CrossRefPubMedGoogle Scholar
  7. 7.
    Shah Z, Lehman JA Jr, Tan J (1981) Does infection play a role in breast capsular contracture? Plast Reconstr Surg 68:34–42CrossRefPubMedGoogle Scholar
  8. 8.
    Netscher DT, Weizer G, Wigoda P, Walker LE, Thornby J, Bowen D (1995) Clinical relevance of positive breast periprosthetic cultures without overt infection. Plast Reconstr Surg 96:1125–1129CrossRefPubMedGoogle Scholar
  9. 9.
    Rios JL, Smith SJ (2006) Enhancing patient outcomes in aesthetic and reconstructive breast surgery using triple antibiotic breast irrigation: six-year prospective clinical study. Plast Reconstr Surg 118(7 Suppl):46S–52SPubMedGoogle Scholar
  10. 10.
    Adams WP Jr (2009) Capsular contracture: what is it? What causes it? How can it be prevented and managed? Clin Plast Surg 36(1):119–126CrossRefPubMedGoogle Scholar
  11. 11.
    Headon H, Kasem A, Kefah Mokbel K (2015) Capsular contracture after breast augmentation: an update for clinical practice. Arch Plast Surg 42(5):532–543CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Stevens WG, Nahabedian MY, Calobrace MB et al (2013) Risk factor analysis for capsular contracture: a 5-year Sientra study analysis using round, smooth, and textured implants for breast augmentation. Plast Reconstr Surg 132(5):1115–1123Google Scholar
  13. 13.
    Jacombs A, Allan J, Hu H et al (2012) Prevention of biofilm-induced capsular contracture with antibiotic-impregnated mesh in a porcine model. Aesthetic Surg J 32(7):886–891Google Scholar
  14. 14.
    Wixtrom RN, Stutman RL, Burke RM, Mahoney AK, Codner MA (2012) Risk of breast implant bacterial contamination from endogenous breast flora, prevention with nipple shields, and implications for biofilm formation. Aesthetic Surg J 32(8):956–963CrossRefGoogle Scholar
  15. 15.
    Thornton JW, Argenta LC, KD MC, Marks MW (1988) Studies on the endogenous flora of the human breast. Ann Plast Surg 20(1):39–42CrossRefPubMedGoogle Scholar
  16. 16.
    Courtiss EH, Goldwyn RM, Anastasi GW (1979) The fate of breast implants with infections around them. Plast Reconstr Surg 63:812–816CrossRefPubMedGoogle Scholar
  17. 17.
    Drinane JJ, Bergman RS, Folkers BL, Kortes MJ (2013) Revisiting triple antibiotic irrigation of breast implant pockets: a placebo-controlled single practice cohort study. Plast Reconstr Surg, Glob Open 1:e55CrossRefGoogle Scholar
  18. 18.
    Adams WP Jr, Rios JL, Smith SJ (2006) Enhancing patient outcomes in aesthetic and reconstructive breast surgery using triple antibiotic breast irrigation: six-year prospective clinical study. Plast Reconstr Surg 118(7 Suppl):46S–52SCrossRefPubMedGoogle Scholar
  19. 19.
    Antevil JL, Muldoon MP, Battaglia M, Green R (2003) Intraoperative anaphylactic shock associated with bacitracin irrigation during revision total knee arthroplasty. J Bone Joint Surg 85(2):339–342CrossRefPubMedGoogle Scholar
  20. 20.
    Greenberger PA (2015) Intraoperative and procedure-related anaphylaxis. J Allergy Clin Immunol: In Practice 3(1):106–107CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Plastic SurgeryRoyal Victoria infirmaryNewcastleUK
  2. 2.Department of Plastic SurgeryJames Cook University HospitalMiddlesbroughUK

Personalised recommendations