Galdiero Marilena, Larocca Fabio, Iovene Maria Rosaria, Francesca Martora, Pieretti Gorizio, D'Oriano Virginia, Franci Gianluigi, Ferraro Giuseppe, d'Andrea Francesco, Nicoletti Giovanni Francesco
Naples, Italy.
From the Department of Plastic, Reconstructive and Aesthetic Surgery, the Department of Experimental Medicine, Section of Virology and Microbiology, Università della Campania Luigi Vanvitelli; the Unit of Plastic, Reconstructive and Aesthetic Surgery, Università Federico II; and the Department of Public Health.
Plast Reconstr Surg. 2018 Jan;141(1):23-30. doi: 10.1097/PRS.0000000000003915.
Capsular contracture around breast implants is a severe and unpredictable complication experienced by up to 50 percent of patients after breast augmentation and reconstruction, and represents a major cause leading to reoperation. Several lines of evidence point to the involvement of subclinical infections and of bacterial biofilm formation.
To reduce the incidence of capsular contracture following mammaplasty, the authors studied the correlation between contamination by exogenous and endogenous bacterial flora and the capacity to develop bacterial biofilm in mammary implants. The authors performed a microbiological study assessing microbial growth of swabs from breast skin, nipple-areola complex, and mammary gland biopsy specimens. Furthermore, the authors compared the results with the data resulting from cultural experiments from biopsy specimens of periprosthetic capsule, contracted or not, and from the surfaces of the relative prosthesis.
Between July of 2012 and July of 2013, a series of 65 female patients from the area of Naples, Italy, and its province, who underwent breast plastic surgery with the use of implants for aesthetic or reconstructive reasons, were included in the study. The authors noticed that there is a greater tendency for capsular contracture to form in oncologic patients who received radiotherapy, patients with precedent capsular contracture, and patients with cutaneous contamination by biofilm-producing microbes.
Although all of the new technical procedures tend to reduce the amount of bacterial charge that comes into contact with the prosthesis at the time of its introduction, a minimal amount must always be taken for granted. This is the rationale for a preventative personalized antibiotic therapy.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
乳房植入物周围的包膜挛缩是隆胸和乳房重建术后高达50%的患者会经历的一种严重且不可预测的并发症，是导致再次手术的主要原因。多条证据表明亚临床感染和细菌生物膜形成与之有关。
为降低乳房成形术后包膜挛缩的发生率，作者研究了外源性和内源性细菌菌群污染与乳腺植入物中细菌生物膜形成能力之间的相关性。作者进行了一项微生物学研究，评估来自乳房皮肤、乳头乳晕复合体和乳腺活检标本的拭子的微生物生长情况。此外，作者将结果与来自假体周围包膜活检标本（无论是否挛缩）以及相关假体表面的培养实验数据进行了比较。
2012年7月至2013年7月，该研究纳入了意大利那不勒斯及其省份的65名女性患者，她们因美容或重建原因接受了使用植入物的乳房整形手术。作者注意到，接受过放疗的肿瘤患者、有包膜挛缩病史的患者以及被产生生物膜的微生物皮肤污染的患者更容易形成包膜挛缩。
尽管所有新的技术程序都倾向于减少假体植入时与假体接触的细菌数量，但总有一个最小量是必然存在的。这就是进行预防性个性化抗生素治疗的基本原理。
临床问题/证据水平：治疗性，四级。
