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 The online version of this article can be found at: can be found at:
Aesthetic Surgery Journal
Additional services and information for
Aesthetic Surgery Journal OnlineFirst, published on June 11, 2013 as doi:10.1177/1090820X13491490
Breast Surgery
Povidone-Iodine Combined With Antibiotic 2013 The American Society for Aesthetic Plastic Surgery, Inc.
Reprints and permission: http://www 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 Abstract
Antibacterial lavage with topical antibiotics may reduce the occurrence of capsular contracture (CC) in breast augmentation.
Objectives: The authors investigate the efficacy of povidone-iodine combined with antibiotic irrigation in reducing the CC rate.
Methods: 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.
Results: 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).
Conclusions: 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- Corresponding Author:
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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