Background: Capsular contracture (CC) is a significant complication and major reason for revision in breast augmentation. Many studies indicate that most bacteria found in contracted capsules originate from the skin, especially that of the nipple-areolar complex (NAC). To prevent implant contamination, protocols without a periareolar incision have been proposed and have become a limitation for breast augmentation. We sought to propose a strategy of proper skin management for periareolar incisions to prevent implant contamination and biofilm-related CC.
Methods: The analyses in this study are based on data collected from February 2017 to July 2020. A total of 129 patients were included, and they were randomized into two groups. The control group was subjected to no skin treatment before the surgery, and the treatment group underwent preoperative cleaning and disinfection of the NAC. We collected bacteriologic swabs used to rub the skin of the NAC and chest after draping and suturing from the control and treatment groups. We assessed the potential risk of detecting bacteria or fungi in the swabs, and we analyzed the data. The relationship between the positive culture rate and complication rate indicated the effectiveness of our strategy.
Results: Initially, 774 swabs were obtained. In the control group, 6 swabs tested positive for pathogens, including 2 NAC swabs positive for Staphylococcus epidermidis (S. epidermidis) after draping and 3 and 1 NAC swabs positive for S. epidermidis and Staphylococcus aureus (S. aureus) after suturing, respectively. All the other samples in the control and treatment groups were negative for bacteria or fungi. All patients had at least 16 months of follow-up. No CC (Baker grades II-IV) was recorded during the follow-up, and the treatment group experienced a better outcome associated with a lower rate of minor complications.
Conclusions: Proper preoperative skin management helps keep the field pristine and potentially prevents implant contamination and even biofilm-related CC. With this strategy, breast augmentation using a periareolar incision or any other approach, even other surgery, could be a safe procedure.
Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Keywords: Biofilm formation; Breast augmentation; Capsular contracture; Microbiota; Periareolar incision; Skin management.
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