Significance of Staphylococcus epidermidis causing subclinical infection
Plastic and Reconstructive Surgery (Impact Factor: 3.33). 05/2005; 115(5):1426-7; author reply 1427-8. DOI: 10.1097/01.PRS.0000157604.65522.BE
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ABSTRACT: Background:Capsular contracture (CC) is a common complication of breast augmentation that is thought to arise from bacterial contamination and subsequent biofilm formation on the implant. Endogenous breast flora expressed through the nipple may contaminate the sterile field during breast augmentation, acting as a possible source for initiation of biofilm formation.Objectives:The authors investigate the incidence of nipple bacterial contamination with endogenous breast flora after standard chest wall sterilization during breast augmentation.Methods:Bacterial contamination of nipples and nipple shields was assessed in a series of 32 consecutive patients presenting for breast augmentation (63 breasts: 31 bilateral procedures and 1 unilateral procedure). After standard sterilization of the chest wall, occlusive nipple shields were applied and breast augmentation was performed. At the conclusion of breast augmentation, the nipple shields were removed and, using the same swab, both the nipple/areolar area and occlusive dressings were cultured.Results:Data from 63 cultured nipples and nipple shields revealed that 22 nipples/nipple shields (34.9%) were positive for bacterial contamination. Three patients, all of whom had negative cultures, developed CC after augmentation.Conclusions:The exposed nipple is a potential source of implant contamination during breast augmentation. An improved understanding of biofilms and related risk factors for CC can provide surgeons with insights for addressing this common complication. Meticulous hemostasis, use of nipple shields, and submuscular device placement may contribute to a lower incidence of CC.Level of Evidence: 4.Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 09/2012; 32(8). DOI:10.1177/1090820X12456841 · 2.03 Impact Factor
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ABSTRACT: Capsular contracture can be an ongoing problem in breast augmentation even with good surgical technique. In the author's practice, a higher incidence of capsular contracture was observed with the use of a periareolar incision than with an inframammary incision. A review of breast augmentations performed from November 2004 through June 2006 was conducted. This analysis included the incision used, the procedure performed, and the development of capsular contracture. The incidence of contracture was 0.59% in the inframammary group and 9.5% in the periareolar group. This increase in capsular contracture with a periareolar incision was statistically significant. Capsular contracture occurring with augmentation performed at the time of a periareolar mastopexy was 8%, which was statistically significant compared with the inframammary group. The difference in contracture rates between a periareolar incision alone and a periareolar mastopexy was not statistically significant. Breast augmentation through a periareolar incision has a higher incidence of capsular contracture than observed with an inframammary incision. This most likely occurs due to an increase in contamination of the breast pocket with intraductal material colonized by bacteria. The periareolar incision is, and will remain, a standard of care. Therefore, this information can help clinicians make a more informed decision regarding incision placement for breast augmentation.Aesthetic Plastic Surgery 04/2008; 32(2):303-6. DOI:10.1007/s00266-007-9061-2 · 1.19 Impact Factor
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