title: Enhancing patient outcomes in aesthetic and reconstructive breast surgery using triple antibiotic breast irrigation: six-year prospective clinical study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Plastic Surgery, Parkland Health and Hospital System, Dallas, Texas, USA. dr@dr-adams.com
authors.forename: William P
authors.initials: WP
authors.lastname: Adams
authors.forename: Jose L
authors.initials: JL
authors.lastname: Rios
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D019928:Breast Implantation / Q000009:adverse effects*; D018427:Breast Implants / Q000009:adverse effects* / Q000382:microbiology; D003286:Contracture / Q000382:microbiology* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011206:Povidone-Iodine / Q000627:therapeutic use*; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000517:prevention & control*; D012086:Reoperation; D007507:Therapeutic Irrigation
chemical_list: D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine