title: Infection prevention in breast implant surgery - A review of the surgical evidence, guidelines and a checklist.
abstract: BACKGROUND
  As a result of increasing use of implant-based breast reconstruction, complications such as infection are being encountered more frequently. Surgical Site Infections (SSIs) cause morbidity for the patient, can lead to capsular contracture or implant loss and are costly to healthcare systems. National Guidelines suggesting methods to reduce SSI related complications have been produced, but are limited in the scope of interventions covered and underlying evidence presented.
  
  
  METHODS
  We performed a literature review encompassing a wide variety of possible SSI prevention strategies. We aimed to present summaries of the available evidence and give pragmatic recommendations as to their validity to use as guidelines for infection prevention strategies for implant-based breast reconstruction.
  
  
  RESULTS
  A lack of high quality data relating to the benefit of SSI prevention strategies in implant-based breast reconstruction exists. Many papers relate to orthopaedic implant surgery, or clean surgery in general. Following review of the evidence, sufficient data exists to support use of perioperative antibiotics at implant-based breast reconstruction, with continuation for an extended period in "high risk" patients. Alcohol containing skin preparations should be used over aqueous solutions. Laminar air flow use is suggested. Theatre traffic should be kept to a minimum, as should duration of operative procedure. The implant pocket should be washed prior to implantation. Double gloving and conductive warming are also endorsed.
  
  
  CONCLUSIONS
  We have produced a perioperative "Theatre Implant Checklist" for SSI prevention in implant-based breast surgery, with a set of pragmatic up to date guidelines, which allows the reader to evaluate the evidence upon which our recommendations are based.
authors.affiliation: The North West Breast Research Collaborative, United Kingdom. Electronic address: simon.barr@manchester.ac.uk.
authors.forename: S P
authors.initials: SP
authors.lastname: Barr
authors.affiliation: The North West Breast Research Collaborative, United Kingdom.
authors.forename: A R
authors.initials: AR
authors.lastname: Topps
authors.affiliation: The North West Breast Research Collaborative, United Kingdom.
authors.forename: N L P
authors.initials: NL
authors.lastname: Barnes
authors.affiliation: The North West Breast Research Collaborative, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Henderson
authors.affiliation: The North West Breast Research Collaborative, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Hignett
authors.affiliation: The North West Breast Research Collaborative, United Kingdom.
authors.forename: R L
authors.initials: RL
authors.lastname: Teasdale
authors.affiliation: The North West Breast Research Collaborative, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: McKenna
authors.affiliation: The North West Breast Research Collaborative, United Kingdom.
authors.forename: J R
authors.initials: JR
authors.lastname: Harvey
authors.affiliation: The North West Breast Research Collaborative, United Kingdom.
authors.forename: C C
authors.initials: CC
authors.lastname: Kirwan
mesh_terms: D018427:Breast Implants; D057189:Checklist; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D016462:Mammaplasty; D017410:Practice Guidelines as Topic; D013530:Surgical Wound Infection / Q000517:prevention & control*
keywords: Breast implants; Infection; Neoplasms; Prevention & control