title: Preventing Breast Implant Contamination in Breast Reconstruction: A National Survey of Current Practice.
abstract: BACKGROUND
  Implant-based breast reconstruction is commonly performed by plastic surgeons worldwide. Bacterial contamination is of paramount concern because of its role in biofilm formation and capsular contracture. Plastic surgeons have adopted a variety of perioperative interventions in efforts to reduce implant contamination; however, definitive evidence supporting these practices is lacking.
  
  
  OBJECTIVE
  The goal of this study was to assess current practice patterns aimed at reducing implant-related infections.
  
  
  METHODS
  A 20-question survey assessing practices aimed at preventing breast implant-associated infections was generated and distributed via SurveyMonkey to members of the American Society of Plastic Surgery whose e-mail addresses were listed on the American Society of Plastic Surgery member Web site in April 2015.
  
  
  RESULTS
  A total of 1979 invitations to participate in the survey were sent, and 253 responses were received during the 4-month study period. Of respondents, 81% were in private practice. Respondents averaged 21 ± 9 years in practice, and 34 ± 50 implant-based breast reconstructions were performed per year. A majority of surgeons used chlorhexidine to prepare the surgical site (52%), a triple antibiotic soak for the implant prior to placement (50%) and povidone-iodine for implant pocket irrigation (44%). A no-touch technique utilizing the Keller funnel was adopted by 69% of surgeons. Regarding antibiotic use in the postoperative period, first-generation cephalosporins (eg, cephalexin, cefadroxil) were used by a majority of surgeons (84%), and the most common duration was until drain removal (45%).
  
  
  CONCLUSIONS
  There is considerable heterogeneity in surgical practices aimed at preventing bacterial contamination in implant-based breast reconstruction. Surgeons may benefit from high-level studies designed to create standardized evidence-based practice guidelines.
authors.affiliation: From the *Division of Plastic & Reconstructive Surgery, University of Maryland School of Medicine; and †Department of Plastic & Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Arvind U
authors.initials: AU
authors.lastname: Gowda
authors.forename: Karan
authors.initials: K
authors.lastname: Chopra
authors.forename: Emile N
authors.initials: EN
authors.lastname: Brown
authors.forename: Sheri
authors.initials: S
authors.lastname: Slezak
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Rasko
mesh_terms: D019928:Breast Implantation / Q000295:instrumentation* / Q000379:methods; D018427:Breast Implants / Q000382:microbiology*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000706:statistics & numerical data; D019990:Perioperative Care / Q000379:methods* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016459:Prosthesis-Related Infections / Q000517:prevention & control*; D014481:United States