Povidone-Iodine Combined With Antibiotic Topical Irrigation to Reduce Capsular Contracture in Cosmetic
Breast Augmentation : A Comparative Study
Salvatore Giordano, Hilkka Peltoniemi, Peter Lilius and Asko Salmi
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Aesthetic Surgery Journal
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Aesthetic Surgery Journal OnlineFirst, published on June 11, 2013 as doi:10.1177/1090820X13491490
Povidone-Iodine Combined With Antibiotic
2013 The American Society for Aesthetic Plastic Surgery, Inc.
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Contracture in Cosmetic Breast Augmentation: DOI: 10.1177/1090820X13491490
Salvatore Giordano, MD; Hilkka Peltoniemi, MD, PhD;
Peter Lilius, MD, PhD; and Asko Salmi, MD, PhD
Antibacterial lavage with topical antibiotics may reduce the occurrence of capsular contracture (CC) in breast augmentation.
The authors investigate the efficacy of povidone-iodine combined with antibiotic irrigation in reducing the CC rate.
The charts of 333 consecutive women who underwent cosmetic breast augmentation during 2 different periods (group A: 2004-2009,
n = 165; group B: 2009-2010, n = 165) were retrospectively reviewed. Al patients in the series underwent augmentation with the same surgeon (A.S.) via the
inframammary approach and dual-plane pocket. In group A, patients received a single perioperative dose of 1.5 g of intravenous cephalothin and 750 mg
of oral cephalexin twice a day for 7 days after discharge. In group B, patients perioperatively received 750 mg of intravenous cefuroxime, and each implant
and pocket were irrigated with 25 mL of a 10% povidone-iodine solution mixed with 750 mg of cefuroxime and 80 mg of gentamicin diluted in 15 mL of
0.9% sodium chloride solution. After discharge, patients received 500 mg of oral levofloxacin once a day for 5 days. Postoperative complications included
occurrence of infection, hematoma, seroma, and CC.
Mean (SD) postoperative follow-up in groups A and B was 24 (13) months and 22 (3) months, respectively. The postoperative superficial
wound infection rate was 1.8% and 1.2%, the seroma rate was 1.8% and 1.2%, and the hematoma rate was 0.6% and 1.2% in groups A and B, respectively.
Ten CC cases (Baker grade 3 or 4) in group A and 1 in group B were reported (6% vs 0.6%; P = .006).
Povidone-iodine and antibiotic irrigation in cosmetic breast augmentation yielded a lower CC rate than standard perioperative antibiotics
Level of Evidence: 3
dual-plane breast augmentation, capsular contracture, topical antibiotics, augmentation mammaplasty, breast implant, prosthesis, biofilm
Accepted for publication December 27, 2012.
Capsular contracture (CC) is a complication of breast aug-
Dr Giordano is a plastic surgery resident in the Department of
mentation that presents as breast induration, which even-
Surgery, Division of Plastic Surgery, Turku University Hospital,
tually may become painful for the patient and cause
Turku, Finland. Dr Peltoniemi, Dr Lilius, and Dr Salmi are consultant
distortion of breast shape and volume. A capsule of fibrous
surgeons at a private plastic surgery clinic in Helsinki, Finland.
material forms around the implant when it is placed. This
Data from this study were presented at the 3rd European Plastic
capsule is initially thin and soft, with little or no effect on
Surgery Research Council (EPSRC); August 25-28, 2011;
the appearance of the breast; however, with time, it may
Hamburg, Germany, and at the 4th Congress of the European
undergo a progressive thickening, become harder, and
Association of Societies of Aesthetic Plastic Surgery (EASAPS);
shrink in such a way that it may alter the breast contours
September 30-October 1, 2011; Milan, Italy.
and produce a range of symptoms varying from local ten-
derness to severe pain.1,2 This pathologic process occurs in
Dr Salvatore Giordano, Department of Surgery, Division of Plastic
response to the implantation of breast prostheses and is
Surgery, Turku University Hospital, OS 299, PL 52, 20521, Turku,
among the most common causes of reoperation following
implant placement.2,3 Previous studies have indicated that
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