In the 2020 issue of Plastic and Reconstructive Surgery Journal there was an article on “The Efficacy of Breast Implant Irrigant Solutions: A Comparative Analysis Using an In Vitro Model.” I know this doesn’t sound super exciting to you, but when we do breast augmentations with saline and silicone breast implants we soak the implant to prevent bacteria. Bacteria = biofilm = infection = capsular contracture = hard yucky breast which may require a surgery to fix.
Currently the gold standard is to use triple antibiotic irrigation. But Bacitracin (one of the triple) has been discontinued, and incidence of drug resistant bacteria are increasing, so the question is what to do next? In the past, people had used betadine, but it fell out of favor because there were concerns it hurt the integrity of the shell of the implant.
This study was to look at betadine (10% povidone-iodine) to see how effective it is against bacteria. This was an in vitro study (meaning in test tubes in the lab, not in the human body)
- They used sterile smooth silicone implant disks
- They immersed the disks in irrigant solution, then incubated the suspensions with MRSA or MRSE (drug resistant bacteria)
- The disks were rinsed and sonicated and then they quantified the bacteria
Findings?
- Povidone iodine reduced bacterial load by a factor of 104 – 105
- Prontosan had 10 fold reduction for all by MRSA
- Triple antibiotic was good against MRSA but not MRSE
- Clorpactin reduced only for one strain of S. Epi strain
Conclusion?
Povidone iodine was the most efficacious of the irrigants at reducing MRSA and MRSE contamination. “Given the recent lifting of the FDA moratorium, larger clinical studies of povidone iodine as a breast implant irrigant are warranted.”
My thoughts?
Betadine was blocked for use with implants years ago because of worries it affects the implant silicone shell, and may lead to early implant leaking and failure. This study shows it is a great substance to kill bacteria. But this study was done on a little disk of silicone in the lab. It doesn’t have a long term view at the integrity of the silicone shell. In the case of breast implants, knowing if it has any effect on the implant itself is important.
I agree that larger studies are important of how it acts in vivo. I am totally for anything which can reduce infection and biofilm risk.
For a summary of the issues with povidone iodine, please read a summary article HERE.