Consequences of infection
So why are we so paranoid about infection around breast implants??
Well that is because the consequences of infection or bacteria around the implant can have a devastating effect. Very very rarely infection can be life threatening however this is usually when it is unrecognized and goes untreated. More commonly if an implant has a short term acute infection it may result in the removal of the implant or prolonged courses of antibiotics. The risk of this is still low at around 0.5%. The major difference between a normal infection in the body and an infection around an implant is that normally antibiotics will kill the bacteria however if they are living on the implant which does not have a blood supply then there is no way to transport the antibiotics to where it is needed and it can be very difficult to eradicate the infection.
There are short and long term sequelae of infection around breast implants – acute infection and capsular contracture.
Even without any acute infection there is now increasing evidence that a more mellow type of bacteria (usually Staph epidermidis) may sit on the surface of the implant for many years without causing overt infection. What it may lead to though is a condition called capsular contracture which may mean the implant needs to be replaced. So for these reasons we are suitably concerned about breast implant infection. Fortunately there are multiple ways to reduce the incidence of infection from the standard figure for most operations of about 4% down to less than 1%.
The things which I do to reduce infection are the following-
- Preoperative showering by the patient
- Intravenous antibiotics given with the anaesthetic through the drip.
- The use of alcoholic chlorhexidine skin preparation
- The use of nipple shields
- The use of water tight and impermeable disposable drapes
- Soaking the implant in a bacteria killing solution before insertion
- The use of new gloves to handle the implant
- Using a Keller Funnel so the implant does not touch the skin on insertion
- Using an antibiotic solution in the implant pocket
- Waterproof dressings
- Postoperative tablet antibiotics
So you can see I am suitably paranoid about infection and its consequences. Yet despite all of these measures infection does still occur and then needs to be managed on its merits.
This opinion piece was brought to you by Dr Damien Grinsell.
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