Implants and Breast Pocket Irrigation: Outcomes of Antibiotic, Antiseptic, and Saline Irrigation

2021 ◽  
Author(s):  
Amanda N Awad ◽  
Adee J Heiman ◽  
Ashit Patel
Keyword(s):  
Systematic Review ◽  
Hypochlorous Acid ◽  
Povidone Iodine ◽  
Breast Implant ◽  
Capsular Contracture ◽  
Saline Irrigation ◽  
Concurrent Use ◽  
Significant Difference ◽  
Poor Outcomes ◽  
Reoperation Rates

Abstract Background Breast implant-associated infection and capsular contracture are challenging complications that can result in poor outcomes following implant-based breast surgery. Antimicrobial irrigation of the breast pocket or implant is a widely accepted strategy to prevent these complications, but the literature lacks an evidence-based consensus on the optimal irrigation solution. Objectives The objective of this systematic review is to compare clinical outcomes, specifically capsular contracture, infection, and reoperation rates, associated with the use of antibiotic, antiseptic, and saline irrigation. Methods A systematic review was performed in March 2020 using the following search terms: “breast implant,” “irrigation,” “antibiotic,” “bacitracin,” “antiseptic,” “povidone iodine,” “betadine,” “low concentration chlorhexidine,” and “hypochlorous acid.” Capsular contracture, infection, and reoperation rates were compared using forest plots. Results Out of the 104 articles were screened, 14 met inclusion criteria. There was no significant difference in capsular contracture rates between antibiotic and povidone iodine irrigation, although the data comparing these two groups was limited and confounded by the concurrent use of steroids. Antibiotic irrigation showed a significantly lower rate of capsular contracture compared to saline irrigation and a lower rate of capsular contracture and reoperation compared to no irrigation at all.. Povidone iodine was associated with lower rates of capsular contracture and reoperation compared to saline irrigation but there was no data on infection rates specific to povidone iodine irrigation. Conclusions Our study supports the use of antibiotic or povidone iodine use for breast implant irrigation. Further research is required to better determine which of these two irrigation types is superior.

scholarly journals Nonsurgical treatment of capsular contracture: Review of clinical studies

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092787
Author(s):  
Anthony Papaconstantinou ◽  
Triantafyllia Koletsa ◽  
Efterpi Demiri ◽  
Kostantinos Gasteratos ◽  
Sofia-Eleni Tzorakoleftheraki ◽  
...  
Keyword(s):  
Systematic Review ◽  
Plastic Surgery ◽  
Clinical Studies ◽  
Breast Implant ◽  
Capsular Contracture ◽  
Nonsurgical Treatment ◽  
Reconstructive Plastic Surgery ◽  
Reconstructive Plastic

Capsular contracture is one of the most distressing complications of breast implant use in both aesthetic and reconstructive plastic surgery procedures. This systematic review was performed to assess the effectiveness of all nonsurgical treatments for established capsular contracture.

Prevention of Capsular Contracture with Montelukast After Insertion of Silicone Implants in Rabbits

2016 ◽  
Vol 13 (10) ◽  
pp. 7623-7627
Author(s):  
Zhenyu Jin ◽  
Ki Yong Hong ◽  
Kyung Won Minn ◽  
Hak Chang ◽  
Ung Sik Jin
Keyword(s):  
Breast Implant ◽  
Capsular Contracture ◽  
White Female ◽  
Silicone Implants ◽  
Control Group ◽  
Tissue Samples ◽  
Significant Difference ◽  
Group A ◽  
The Right ◽  
Experimental Group

Capsular contracture is the most common complication after insertion of silicone implants during breast implant surgery. The discovery that myofibroblasts play an important role in the formation of hypertrophic scars led to the development of pharmacological drugs such as zafirlukast, which prevents capsular contracture by resisting the above mechanism. As a result, the author sought to investigate the effect of the anti-leukotriene montelukast on capsular contracture. Ten white female New Zealand rabbits, each weighing approximately 3 kg, were used as subjects. Through bilateral incision of the midback area, the prostheses were inserted on the subpanniculus carnosus plane. Once the silicone prostheses had been inserted, the right implant was injected with 10 mL of montelukast (10 µg/mL), and the left implant was injected with 10 mL of normal saline. Eight weeks after the procedure, the capsular pressure was measured via tonometry using a circular glass piece weighing 42.7 g. The tissue samples were then extracted, and their thicknesses were measured using hematoxylin-eosin stain and Masson trichrome stain. The average pressure was 4.23±0.99 mmHg in the control group and 3.71±0.51 mmHg in the experimental group, a statistically significant difference (p = 0.02). The average capsular thickness was 947.938±300 µm in the control group and 709.672±274 µm in the experimental group, a statistically significant difference (p = 0.028). The author confirmed that montelukast injections during silicone prosthesis insertion decreased the formation of capsular contracture.

scholarly journals One Versus 2 Venous Anastomoses in Free Flap Surgery: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 26 (2) ◽  
pp. 91-98
Author(s):  
Jennifer L. K. Matthews ◽  
Noor Alolabi ◽  
Forough Farrokhyar ◽  
Sophocles H. Voineskos
Keyword(s):  
Systematic Review ◽  
Free Flap ◽  
Meta Analysis ◽  
Venous Congestion ◽  
Flap Surgery ◽  
Flap Failure ◽  
Free Flap Surgery ◽  
Significant Difference ◽  
Reoperation Rates ◽  
Venous Flap

Background: The necessity of a second venous anastomosis in free flap surgery is controversial. The purpose of this systematic review is to determine whether venous flap failure and reoperation rates are lower when 2 venous anastomoses are performed. The secondary objective is to determine whether venous flap failure and reoperation rates are lower when the 2 veins are from 2 different drainage systems. Methods: A comprehensive search of the literature identified relevant studies. Investigators independently extracted data on rates of flap failure and reoperation secondary to venous congestion. A meta-analysis was performed; odds ratios (ORs) were pooled using a random-effects model and 95% confidence intervals (CIs). Results: Of 18 190 studies identified, 15 were included for analysis. The mean sample size was 287 patients (minimum = 102, maximum = 564). No statistically significant difference in venous flap failure was found when comparing 1 versus 2 venous anastomoses (OR: 1.35; 95% CI: 0.46-3.93). A significant decrease in reoperation rate due to venous congestion was shown (OR: 3.03; 95% CI: 1.64-5.58). The results favor using 2 veins from 2 different systems over veins from the same system (OR: 0.16; 95% CI: 0.02-1.27). Conclusions: There is low-quality evidence suggesting that the use of 2 venous anastomoses will lower the rate of reoperation due to venous congestion. There are insufficient data published to meaningfully compare outcomes of flaps with 2 venous anastomoses from different systems to flaps with anastomoses from the same system.

scholarly journals 1443 Comparison of Outcomes Between Immediate Direct-to-Implant Breast Reconstruction versus Two-Stage Implant Breast Reconstruction; a Systematic Review and Meta-analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
O Kelly ◽  
I Balasubramanian ◽  
C Cullinane ◽  
R Prichard
Keyword(s):  
Systematic Review ◽  
Breast Reconstruction ◽  
Meta Analysis ◽  
Capsular Contracture ◽  
Tissue Expander ◽  
Immediate Breast Reconstruction ◽  
Two Stage ◽  
Significant Difference ◽  
Implant Reconstruction ◽  
Implant Breast Reconstruction

Abstract Background Direct-to-implant (DTI) breast reconstruction is increasingly performed as the preferred method of immediate breast reconstruction following mastectomy. The proposed advantages of DTI over two-stage tissue expander (TE)/implant reconstruction relate to fewer surgical procedures. This systematic review and meta-analysis aims to evaluate the safety and efficacy of DTI versus conventional TE/implant breast reconstruction. Method A systematic review was performed (PubMed, Embase, Scopus) to identify relevant studies that compared outcomes between DTI and TE/Implant reconstructions. Publications up to October 2020 were included. The primary outcome was overall complication rate. Secondary outcomes included infection rate and implant loss. Results Nineteen studies, including 32,971 implant-based breast reconstructions, were analysed. Median age was 48 years. Mean BMI was 25.9. There was no statistically significant difference between the two groups. Duration of follow up ranged from 1-60 months. Overall complications were significantly more likely to occur in the DTI group (OR 1.81 [1.17-2.79]). Overall complications refers to all reported complications including seroma, haematoma, would dehiscence, infection, skin necrosis and capsular contracture. Implant loss was also significantly higher in the DTI cohort (OR 1.31 [1.12-1.78]). There was no significant difference in infection rates between the two groups. Subgroup analyses, focusing on high-powered multicentre studies showed that the risks of overall complications were significantly higher in the DTI group (OR 1.51 [1.06-2.14]). Conclusions This meta-analysis demonstrates significantly greater risk of complications and implant loss in the DTI breast reconstruction group. These findings serve to aid both patients and clinicians in the decision-making process regarding implant reconstruction following mastectomy

scholarly journals Rapid initiation of nasal saline irrigation to reduce morbidity and mortality in COVID+ outpatients: a randomized clinical trial compared to a national dataset

2021 ◽  
Author(s):  
Amy L. Baxter ◽  
Kyle R. Schwartz ◽  
Ryan W. Johnson ◽  
Ann-Marie Kuchinski ◽  
Kevin M. Swartout ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Conflict Of Interest ◽  
Povidone Iodine ◽  
Morbidity And Mortality ◽  
Saline Irrigation ◽  
Nasal Irrigation ◽  
Link Type ◽  
Phone Calls ◽  
Significant Difference

AbstractImportanceSARS-CoV-2 enters the nasopharynx to replicate; mechanical debridement with nasal irrigation soon after diagnosis could reduce morbidity and mortality.ObjectiveTo determine whether initiating nasal irrigation after COVID-19 diagnosis reduces hospitalizations and death, and whether irrigant composition impacts severity.DesignUnblinded randomized clinical trial of two nasal irrigation protocols in outpatients PCR positive for SARS-CoV-2, nested in a prospective case:cohort using laboratory-confirmed cases in the CDC COVID-19 Case Surveillance dataset.SettingSingle-lab community testing facility associated with the emergency department (ED) in Augusta, GA.ParticipantsA consecutive sample of outpatients 55 years and older were contacted from daily COVID-19+ lab reports between September 24 and December 21 of 2020. Patients without supplemental oxygen use or cognitive barriers agreeing to same-day irrigation initiation were remotely consented. Among 826 screened, 321 were unable to be reached, 132 were ineligible, 294 refused participation, and 79 participants were enrolled.InterventionsParticipants were randomly assigned adding 2.5 mL povidone-iodine 10% or 2.5 mL sodium bicarbonate to 240ml of isotonic nasal irrigation twice daily for 14 days.Main Outcomes and MeasuresThe primary outcome was hospitalization or death from COVID-19 within 28 days of enrollment by daily self-report confirmed with phone calls and hospital records, compared to the CDC Surveillance Dataset covering the same time. Secondary outcomes compared symptom resolution by irrigant additive.ResultsSeventy-nine participants were enrolled (mean [SD] age, 64 [8] years; 36 [46%] women; 71% Non-Hispanic White). Analyzed by intention-to-treat, by day 28, COVID-19 symptoms resulted in 1/42 hospitalizations in those irrigating with alkalinization, 0/37 in the povidone-iodine group, (1.27%) and no deaths. Of nearly three million CDC cases, 9.14% were known to be hospitalized, with an additional 1.5% mortality in those without hospitalization data. The total risk of hospitalization or death (10.6%) was 8.4 times that of enrolled patients (SE=2.74; P=.006). 62 completed daily surveys (78%), averaging 1.8 irrigations/day. Eleven had irrigation complaints, and four discontinued. There were no significant differences by additive.ConclusionSARS-CoV-2+ participants initiating nasal irrigation were over 8 times less likely to be hospitalized than the national rate.Trial RegistrationClinicalTrial.gov Identifier: NCT04559035Author ApprovalAll authors have filled out ICMJE and approved submission.Conflict of Interest StatementMaterials were provided by Neilmed Inc. and Rhinosystems Inc. The study was supported by funding from the Bernard and Anne Gray Donor Advised Fund Community Foundation for Greater Atlanta, Neilmed Inc., and Rhinosystems. No authors have conflict of interest.Key PointsQuestionAfter testing positive for COVID-19, will rapidly initiating nasal irrigation with alkaline or povidone-iodine isotonic solution reduce the risk of morbidity and mortality compared to a national dataset?FindingsIn this randomized trial of 79 older adults nested in a case:control with the CDC COVID-19 National Dataset, 1.27% of participants initiating nasal irrigation were hospitalized or died, compared to 10.6%, a significant difference.MeaningIn older outpatients testing positive for SARS-CoV-2 who initiated nasal irrigation rapidly after diagnosis, risk of hospitalization or death was eight times lower than national rates reported by the CDC.

Reduced capsular contracture with smooth and textured breast implants following submuscular mammoplasty: systematic literature review

2021 ◽  
Author(s):  
Lie Zhu ◽  
Jie Zhu ◽  
Yuxin Qian ◽  
Hua Jiang
Keyword(s):  
Systematic Review ◽  
Literature Search ◽  
Primary Outcome ◽  
Capsular Contracture ◽  
Breast Implants ◽  
Implant Surface ◽  
Reconstruction Surgery ◽  
Significant Difference ◽  
Risk Rate ◽  
Present Systematic Review

Background: Capsular contracture is common in breast augmentation and reconstruction surgery. The present systematic review discusses the safety of textured and smooth implants in the submuscular position. Methods: A literature search was conducted on PubMed and EMBASE from inception until June 2020. The primary outcome was reduction of capsular contracture (Baker grade); others included time of capsular contracture onset, implant position/rupture rate/surface, hematoma/seroma risk, surgeon assessment and patient satisfaction. A total of 7731 patients were included from six publications. Results: The overall risk rate for capsular contracture increased from 7.6 to 25% in 10 years. The capsular contracture rates in textured and smooth implants were 3–14% and 6–20%, respectively, and no significant difference between implants was observed when the implants were placed submuscularly. Submuscular placement and textured implants also reduced the incidence of other complications. Conclusion: This systematic review suggests that appropriate placement reduces capsular contracture rate, irrespective of implant surface.

scholarly journals Antibiotic Irrigation of Pocket for Implant-Based Breast Augmentation to Prevent Capsular Contracture: A Systematic Review

2018 ◽  
Vol 26 (2) ◽  
pp. 110-119 ◽  
Author(s):  
Osama A. Samargandi ◽  
Nadim Joukhadar ◽  
Sarah Al Youha ◽  
Achilleas Thoma ◽  
Jason Williams
Keyword(s):  
Breast Augmentation ◽  
Controlled Trial ◽  
Capsular Contracture ◽  
In Vivo Studies ◽  
Controlled Study ◽  
Saline Irrigation ◽  
Randomized Controlled ◽  
Randomized Studies ◽  
Significant Difference

Background: In vitro and in vivo studies have described a number of different antibiotic solutions for irrigation of the pocket in implant-based breast augmentation in an attempt to prevent the formation of capsular contracture (CC). Our objective was to evaluate the evidence that antibiotic irrigation reduced the rate of CC. Methods: A systematic search of MEDLINE, EMBASE, and CENTRAL was conducted from inception to January 2016. We included studies which examined the use of intraoperative antibiotic irrigation in women undergoing primary breast augmentation. Our primary outcome was the rate of CC. Included studies were assessed for methodological quality using validated tools. Results: Seven studies were included in the final analysis: 1 randomized controlled trial (RCT) and 6 non-randomized studies. The mean follow-up ranged from 14 to 72 months. The rate of CC was less than 2% in 8 studies, between 3% and 6% in 4 studies, and 13.9% in 1 study. Included studies demonstrated significant clinical and methodological heterogeneity. The solitary low-quality RCT concluded that antibiotic irrigation was superior to saline irrigation. Three non-randomized studies demonstrated no significant difference in the rate of CC with the use of antibiotics. One non-randomized controlled study showed that the use of mixture of antibiotic and povidone-iodine significantly lowered the rate of CC. Conclusions: The available evidence on the use of antibiotic irrigation to prevent CC is weak and it is based on studies with high risk of bias. Methodologically robust studies are necessary to answer the question whether antibiotic breast pocket irrigation prevents CC.

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