The Efficacy of Breast Implant Irrigant Solutions: A Comparative Analysis Using an In Vitro Model

Ngaage, Ledibabari M.; Elegbede, Adekunle; Brao, Kristen; Chopra, Karan; Gowda, Arvind U.; Nam, Arthur J.; Ernst, Robert K.; Shirtliff, Mark E.; Harro, Janette M.; Rasko, Yvonne M.

doi:10.1097/prs.0000000000007028

Cited by 28 publications

(44 citation statements)

References 49 publications

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“…epidermidis shows 1 log reduction after 30 minutes of exposure. 50 Combined, these results suggest that a much longer exposure time may be required to significantly reduce biofilm-associated bacteria compared with planktonic bacteria. Given the varying clinical utilization patterns and protocols, TAB effectiveness may vary greatly, depending on the amount of residual antibiotic solution that may persist in the pocket.…”

Section: Discussionmentioning

confidence: 91%

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

Jewell¹,

Bionda²,

Moran³

et al. 2021

Aesthetic Surgery Journal

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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.

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Section: Discussionmentioning

confidence: 91%

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

Jewell¹,

Bionda²,

Moran³

et al. 2021

Aesthetic Surgery Journal

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“…This study also investigated defined endpoints for exposure to antimicrobial solutions with the active agent neutralized from further activity at these timepoints; therefore, the results do not preclude that TAB may be more efficacious when left in the breast pocket for longer contact times as has been suggested by other studies. 22 , 38 Furthermore, the assay setup in this study is a simplified 2-dimensional in vitro testing platform, which did not utilize surrogate silicone surfaces in lieu of breast implant materials; however, a recently published study utilized smooth silicone coupons and demonstrated very similar results regarding PI and TAB efficacy against S . aureus and S .…”

Section: Discussionmentioning

confidence: 99%

“…epidermidis , lending credence to the applicability of our results to silicone surfaces. 38 Given these limitations, the correlation between the results of these in vitro studies and clinical outcomes is not known and could be further investigated through appropriate in vivo preclinical studies and clinical work. However, these in vitro findings are supported by the outcomes reported for utilizing PI in pocket irrigation in recent clinical studies.…”

Section: Discussionmentioning

confidence: 99%

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

Jewell¹,

Hariri²,

Lantz³

et al. 2020

Aesthetic Surgery Journal

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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.

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“…While in cosmetic breast augmentation its incidence is around 0.1–1.5%, it rises to 5.8–28% in breast reconstruction, depending on the study ( ISAPS, 2019 ). Consequences of these infections are a delay in starting adjuvant chemotherapy or radiotherapy treatment and additional surgeries with a significant increase in the risk of reconstructive failure and/or implant loss ( Ranganathan et al, 2018 ; Ngaage et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

“…As for BI colonizing microorganisms, the most frequently isolated in implant culture is Staphylococci ( S. epidermidis and S. aureus ) and anaerobes, which are associated with treatment-resistant infection and implant loss ( Del Pozo et al, 2009 ; Deva et al, 2013 ; Rieger et al, 2013 ; del Pozo and Auba, 2015 ; Ngaage et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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BackgroundIn the practice of breast augmentation and reconstruction, implant irrigation with various solutions has been widely used to prevent infection and capsular contracture, but to date, there is no consensus on the optimal protocol to use. Recently, application of povidone iodine (PI) for 30 min has shown in vitro to be the most effective irrigating formula in reducing contamination in smooth breast implants. However, as 30 min is not feasible intraoperatively, it is necessary to determine whether shorter times could be equally effective as well as to test it in both smooth and textured implants.MethodsWe tested the efficacy of 10% PI at 1′, 3′, and 5′ against biofilms of 8 strains (2 ATCC and 6 clinical) of Staphylococcus spp. on silicone disks obtained from Mentor® and Polytech® implants of different textures. We analyzed the percentage reduction of cfu counts, cell viability and bacterial density between treatment (PI) and control (sterile saline, SS) groups for each time of application. We consider clinical significance when > 25% reduction was observed in cell viability or bacterial density.ResultsAll textured implants treated with PI at any of the 3 exposure times reduced 100% bacterial load by culture. However, none of the implants reached enough clinical significance in percentage reduction of living cells. Regarding bacterial density, only 25–50 μm Polytxt® Polytech® implants showed significant reduction at the three PI exposure times.ConclusionPI is able to inhibit bacterial growth applied on the surface of breast implants regardless of the exposure time. However, no significant reduction on living cells or bacterial density was observed. This lack of correlation may be caused by differences in texture that directly affect PI absorption.

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The Efficacy of Breast Implant Irrigant Solutions: A Comparative Analysis Using an In Vitro Model

Cited by 28 publications

References 49 publications

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

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

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

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

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