title: Risk of breast implant bacterial contamination from endogenous breast flora, prevention with nipple shields, and implications for biofilm formation.
abstract: BACKGROUND
  Capsular contracture (CC) is a common complication of breast augmentation that is thought to arise from bacterial contamination and subsequent biofilm formation on the implant. Endogenous breast flora expressed through the nipple may contaminate the sterile field during breast augmentation, acting as a possible source for initiation of biofilm formation.
  
  
  OBJECTIVE
  The authors investigate the incidence of nipple bacterial contamination with endogenous breast flora after standard chest wall sterilization during breast augmentation.
  
  
  METHODS
  Bacterial contamination of nipples and nipple shields was assessed in a series of 32 consecutive patients presenting for breast augmentation (63 breasts: 31 bilateral procedures and 1 unilateral procedure). After standard sterilization of the chest wall, occlusive nipple shields were applied and breast augmentation was performed. At the conclusion of breast augmentation, the nipple shields were removed and, using the same swab, both the nipple/areolar area and occlusive dressings were cultured.
  
  
  RESULTS
  Data from 63 cultured nipples and nipple shields revealed that 22 nipples/nipple shields (34.9%) were positive for bacterial contamination. Three patients, all of whom had negative cultures, developed CC after augmentation.
  
  
  CONCLUSIONS
  The exposed nipple is a potential source of implant contamination during breast augmentation. An improved understanding of biofilms and related risk factors for CC can provide surgeons with insights for addressing this common complication. Meticulous hemostasis, use of nipple shields, and submuscular device placement may contribute to a lower incidence of CC.
authors.affiliation: LSCI Inc, Springfield, Virginia, USA.
authors.forename: Roger N
authors.initials: RN
authors.lastname: Wixtrom
authors.forename: Ross L
authors.initials: RL
authors.lastname: Stutman
authors.forename: Renee M
authors.initials: RM
authors.lastname: Burke
authors.forename: Amy K
authors.initials: AK
authors.lastname: Mahoney
authors.forename: Mark A
authors.initials: MA
authors.lastname: Codner
mesh_terms: D000328:Adult; D019072:Antibiotic Prophylaxis; D001458:Bandages; D018441:Biofilms; D001940:Breast / Q000382:microbiology / Q000601:surgery*; D019928:Breast Implantation / Q000009:adverse effects* / Q000295:instrumentation; D018427:Breast Implants / Q000009:adverse effects*; D004866:Equipment Contamination / Q000517:prevention & control*; D004867:Equipment Design; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D057910:Implant Capsular Contracture / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D015994:Incidence; D017053:Infection Control / Q000295:instrumentation* / Q000379:methods; D008875:Middle Aged; D009558:Nipples / Q000382:microbiology / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D012307:Risk Factors; D016896:Treatment Outcome