title: Povidone-iodine combined with antibiotic topical irrigation to reduce capsular contracture in cosmetic breast augmentation: a comparative study.
abstract: BACKGROUND
  Antibacterial lavage with topical antibiotics may reduce the occurrence of capsular contracture (CC) in breast augmentation.
  
  
  OBJECTIVE
  The authors investigate the efficacy of povidone-iodine combined with antibiotic irrigation in reducing the CC rate.
  
  
  METHODS
  The charts of 330 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. All 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 in this series of patients.
authors.affiliation: Department of Surgery, Division of Plastic Surgery, Turku University Hospital, Turku, Finland. salvatore.giordano@gmail.com
authors.forename: Salvatore
authors.initials: S
authors.lastname: Giordano
authors.forename: Hilkka
authors.initials: H
authors.lastname: Peltoniemi
authors.forename: Peter
authors.initials: P
authors.lastname: Lilius
authors.forename: Asko
authors.initials: A
authors.lastname: Salmi
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018441:Biofilms / Q000187:drug effects; D019928:Breast Implantation / Q000009:adverse effects / Q000379:methods*; D018427:Breast Implants / Q000009:adverse effects*; D016022:Case-Control Studies; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057910:Implant Capsular Contracture / Q000517:prevention & control*; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011206:Povidone-Iodine / Q000627:therapeutic use*; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D007507:Therapeutic Irrigation / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D011206:Povidone-Iodine
keywords: augmentation mammaplasty; biofilm; breast implant; capsular contracture; dual-plane breast augmentation; prosthesis; topical antibiotics