Benito-Ruiz Jesús
From the Private practice at Antiaging Group Barcelona, Clinica Tres Torres, Barcelona, Spain.
Ann Plast Surg. 2017 Apr;78(4):397-402. doi: 10.1097/SAP.0000000000000895.
Infection after breast augmentation occurs in 1.1% to 2.5% of patients. Bacterial contamination of the implants could explain some complications of breast implant surgery, including infection, capsular contracture and even anaplastic large cell lymphoma. Because of the evidence of bacterial spread from the nipple, nipple shields have been proposed as a routine maneuver to avoid contamination of the implants.
To determine if nipple shields are useful in transaxillary breast augmentation.
A culture was obtained from the dressing (nipple shield) in 26 patients with transaxillary incision, and follow-up lasted for 18 months. A retrospective study of patients undergoing breast augmentation between 2008 and 2012 was conducted as well to know our rate of infections. A total of 753 patients between the ages of 18 and 62 years, with a mean age of 34 years, were identified. Of these 753 patients, most underwent surgery using a transaxillary incision (72.5%). The most common placement plane was subfascial (59.2%), and in most cases, an anatomical prosthesis (78%) was used.
No cases of infection or capsular contracture were observed in the study group. However, 13.5% of the breasts had positive cultures of swabs taken under the nipple shields. Staphylococcus epidermidis and Enterococcus faecalis were isolated from the nipple culture. Within the retrospective study, we detected 2 cases of acute infection (0.26%) and 5 cases of late infection (0.66%). The acute infections were caused by Staphylococcus aureus. In the late infections, Pseudomonas aeruginosa was isolated in 3 cases, and S. aureus was isolated in 1 case.
Nipple shields did not make any difference for outcomes when using the transaxillary method. Acute infections seem to occur more frequently via the areola route. Late infections seem to have a hematogenous component because an infectious background was present in all cases.
隆胸术后感染发生率为1.1%至2.5%。植入物的细菌污染可能解释隆胸手术的一些并发症，包括感染、包膜挛缩甚至间变性大细胞淋巴瘤。由于有证据表明细菌可从乳头传播，因此有人提出使用乳头防护罩作为避免植入物污染的常规措施。
确定乳头防护罩在经腋窝隆胸术中是否有用。
对26例经腋窝切口的患者的敷料（乳头防护罩）进行培养，并随访18个月。还对2008年至2012年期间接受隆胸手术的患者进行了回顾性研究，以了解我们的感染率。共确定了753例年龄在18至62岁之间的患者，平均年龄为34岁。在这753例患者中，大多数采用经腋窝切口进行手术（72.5%）。最常见的植入平面是筋膜下（59.2%），在大多数情况下，使用解剖型假体（78%）。
研究组未观察到感染或包膜挛缩病例。然而，13.5%的乳房在乳头防护罩下采集的拭子培养结果为阳性。从乳头培养物中分离出表皮葡萄球菌和粪肠球菌。在回顾性研究中，我们检测到2例急性感染（0.26%）和5例迟发性感染（0.66%）。急性感染由金黄色葡萄球菌引起。在迟发性感染中，3例分离出铜绿假单胞菌，1例分离出金黄色葡萄球菌。
采用经腋窝法时，乳头防护罩对手术结果没有任何影响。急性感染似乎更常通过乳晕途径发生。迟发性感染似乎有血行感染成分，因为所有病例均存在感染背景。
