The Aesthetic Surgery Journal August 2019 had an article which sounds super boring, but is oh-so-important. “Back to Basics: Could the Preoperative skin Antiseptic Agent Help Prevent Biofilm Related Capsular Contracture?”
Why do we care? Biofilm is a low grade bacterial colonization of the breast implant which can lead to capsular contracture, the hardening of the scar your body forms around the breast implant. (Please read my copious blogs on the subject HERE.) BIOFILM = LOW GRADE INFECTION = BAD.
So we prep your skin prior to surgery to remove bacteria from the skin (I have my patients do it daily for days ahead of time). Bacteria are everywhere, even in surgery after we do our sterile prep and drape. This study looked to find if the type of antiseptic agent used would have an effect.
STUDY: 90% of bacterial found in capsules and implants removed from patients with aggressive capsular contractures are in the skin bacteria biome, particularly Staph Epi.
- They used two different skin preps: Povidone Iodine vs. Chlorhexidine gluconate.
- All surgeries were primary breast augmentation through a periareolar approach.
- 31 patients were in each arm of the study.
- They were followed on average for 18 months after surgery.
RESULTS: There was a statistically significant difference. Capsular contracture was HIGHER for those using betadine. There were NO capsular contractures reported for the chlorhexidine group.
My thoughts?
I love it! I give all my patients chlorhexidine wash to do daily for days ahead of their surgery. When we have choices as to what we do, like how do we prep the skin, studies like this are helpful to help us use science to pick the best one.
They theorize the chlorhexidine has a longer residual action and activity in the presence of blood or serum.
Of note, this study was small, it was a retrospective study, follow up time was shorter (under 2 years), they did the surgery through the areola (higher risk for capsular contracture), they don’t talk about what other steps they took (did they use a Keller funnel? triple antibiotic irrigation? tegaderm over the nipple?), they don’t talk about gel vs. saline implants (gels come prefilled, so likely touch the skin more during implantation than saline do). They do mention most implants were textured and in a subglandular (higher risk for capsular contracture) position.