povidone-iodine and Contracture

We performed a prospective, concurrently controlled, and blinded 4-year clinical study on 60 patient volunteers to determine the effects of two independent variables, McGhan's Biocell texturization and Betadine antibacterial irrigation, on the incidence of fibrous capsular contracture around saline-inflatable implants following retromammary augmentation. Each patient was randomly assigned both a textured and a smooth implant and both saline and Betadine irrigation so that each patient served as her own control. The textured devices irrigated with Betadine experienced an overall incidence of contracture of only 4 percent compared with 50 percent for the smooth devices irrigated with saline solution. The Betadine-irrigated devices in general had a lower incidence of contracture than the saline-irrigated devices, and the textured-surface devices in general had a lower incidence of contracture than the smooth devices. Antibacterial irrigation and surface texturization may work in a cumulative manner to reduce the early incidence of capsular contracture.

Topics: Adult; Breast Implants; Contracture; Female; Humans; Mammaplasty; Middle Aged; Postoperative Complications; Povidone-Iodine; Prospective Studies; Therapeutic Irrigation

Topics: Breast Implantation; Breast Implants; Contracture; Esthetics; Humans; Mammaplasty; Povidone-Iodine; Therapeutic Irrigation

Topics: Breast Implantation; Breast Implants; Contracture; Esthetics; Humans; Mammaplasty; Povidone-Iodine; Therapeutic Irrigation

Capsular contracture remains one of the most commonly reported complications in aesthetic and reconstructive breast patients. Previous in vitro studies from the authors' laboratory have recommended a new triple antibiotic povidone-iodine irrigation (2000) and subsequently a triple antibiotic non-povidone-iodine-containing irrigant (2001) to optimize broad-spectrum coverage of various bacteria implicated in capsular contracture; however, the clinical efficacy of these in vitro studies remains unproven. The purpose of this study was to determine the clinical efficacy for the previously reported triple antibiotic breast irrigation. The cost-effectiveness of universal application of irrigation solutions in breast prosthesis surgery was analyzed as well.. Patients undergoing aesthetic and reconstructive breast implant procedures were treated with a standardized operative technique, including the use of triple antibiotic breast irrigation by a single surgeon. Capsular contracture was assessed using a simplified Baker scale and graded by two independent caregivers to maximize objectivity and consistency. Additional complications were also recorded, including reoperation. Patient charges for antibiotic irrigation and reoperation for contracture were determined and compared.. A total of 335 patients operated on since 1997 were evaluated prospectively. They ranged in age from 18 to 86 years, and the mean follow-up was 14 months (range, 6 to 75 months). The rate of grade III/IV capsular contracture in the study groups was 1.8 percent for patients undergoing primary breast augmentation. Patients undergoing augmentation-mastopexy had a grade III/IV contracture rate of 0 percent. Breast reconstruction patients had a 9.5 percent rate of grade III/IV contracture.. Triple antibiotic breast irrigation is clinically associated with a low incidence of capsular contracture compared with other published reports, and its clinical efficacy supports previously published in vitro studies. Application of triple antibiotic irrigation is recommended for all aesthetic and reconstructive breast procedures and is cost effective.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Breast Implantation; Breast Implants; Contracture; Female; Humans; Middle Aged; Povidone-Iodine; Prospective Studies; Prosthesis-Related Infections; Reoperation; Therapeutic Irrigation

Irrigation of breast implants and breast implant pockets with various solutions, including povidone iodine, has been a common practice among plastic surgeons for many years. Recent reports of potential weakening of silicone tubing have led the Food and Drug Administration to pronounce any contact of povidone iodine with breast implants a contraindication. An in vitro experimental study was undertaken to assess the effect of povidone iodine on the physical properties of silicone breast implant shells. Identical specimens were obtained from the shells of silicone breast implants according to published standards. The specimens were randomly assigned to eight groups of five and incubated in various solutions of decreasing concentration of povidone iodine (10% to 0.01%), and a control group (0.9% saline) was used. The containers were stored in a warming cabinet at 37 degrees C for 4 weeks. Testing of the specimens for tensile strength following 4 weeks of incubation showed no significant difference among any of the groups, including the control group. In addition, no correlation was shown between the concentration of the solution used and the tensile strength of the specimens.

Topics: Anti-Infective Agents, Local; Breast Implants; Contracture; Humans; In Vitro Techniques; Povidone-Iodine; Prosthesis-Related Infections; Silicone Gels; Staphylococcal Infections; Staphylococcus epidermidis; Therapeutic Irrigation

Topics: Animals; Anti-Infective Agents; Contracture; In Vitro Techniques; Mammary Glands, Animal; Methods; Mice; Mice, Inbred Strains; Povidone; Povidone-Iodine; Prostheses and Implants; Silicones; Staphylococcal Infections; Surgical Wound Infection; Tensile Strength