title: Revisiting Triple Antibiotic Irrigation of Breast Implant Pockets: A Placebo-controlled Single Practice Cohort Study.
abstract: BACKGROUND
  Capsular contracture is the most common complication following primary augmentation mammoplasty. It remains poorly understood but is attributed to subclinical infection, immunologic response to breast implants, and chronic inflammatory changes caused by the presence of the implants. The infectious theory of contracture has lead to the practice of irrigating implant pockets with a triple antibiotic solution. The purpose of this study was to determine if antibiotic irrigation reduced the incidence and severity of capsular contracture compared with saline irrigation.
  
  
  METHODS
  A cohort study enrolling all patients having undergone primary augmentation mammoplasty performed by surgeon A and surgeon B between 2011 and 2012 for all women satisfying inclusion and exclusion criteria was conducted. The only difference in surgical technique was the use of antibiotic irrigation by surgeon B. A chi-square test and analysis of variance with predetermined 95% confidence intervals were performed.
  
  
  RESULTS
  Fifty-five patients were operated on. Twenty-eight of surgeon A's patients were included, ranging in age from 22 to 50 with a mean follow-up time of 1.8 years. Twenty-seven of surgeon B's patients were included, ranging in age from 22 to 56 with a mean follow-up time of 1.6 years. Rate of capsular contracture was 3.6% (surgeon A) and 3.7% (surgeon B). Chi-square statistic was found to be 0.0014 (P = 0.97) and analysis of variance F value was 1 (P = 0.39).
  
  
  CONCLUSIONS
  Triple antibiotic breast irrigation is not associated with a significant reduction in the incidence or severity of capsular contracture compared with sterile saline when high-quality surgical technique is used.
authors.affiliation: College of Osteopathic Medicine and Surgery, Des Moines University, Des Moines, Iowa; and Bergman/Folkers Plastic Surgery, Des Moines, Iowa.
authors.forename: James J
authors.initials: JJ
authors.lastname: Drinane
authors.affiliation: College of Osteopathic Medicine and Surgery, Des Moines University, Des Moines, Iowa; and Bergman/Folkers Plastic Surgery, Des Moines, Iowa.
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Bergman
authors.affiliation: College of Osteopathic Medicine and Surgery, Des Moines University, Des Moines, Iowa; and Bergman/Folkers Plastic Surgery, Des Moines, Iowa.
authors.forename: Bryan L
authors.initials: BL
authors.lastname: Folkers
authors.affiliation: College of Osteopathic Medicine and Surgery, Des Moines University, Des Moines, Iowa; and Bergman/Folkers Plastic Surgery, Des Moines, Iowa.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Kortes