Epps Mathew T, Langsdon Sarah, Pels Taylor K, Lee Tara M, Thurston Todd, Brzezienski Mark A
Department of Plastic and Reconstructive Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tenn.
University of Tennessee College of Medicine, Memphis, Tenn.
Plast Reconstr Surg Glob Open. 2019 Aug 8;7(8):e2310. doi: 10.1097/GOX.0000000000002310. eCollection 2019 Aug.
Breast augmentation is among the most common procedures performed in the United States. Though bacterial contamination of breast prostheses is associated with adverse sequelae, there are no universally accepted guidelines and limited best practice recommendations for antimicrobial breast pocket irrigation. We designed a survey to identify pocket irrigation preferences and antimicrobial techniques during implant-based breast augmentation among American Society of Plastic Surgeons (ASPS) members.
In January 2018, a random cohort of 2,488 ASPS members was surveyed. Questions queried breast pocket irrigation methods and surgical techniques including implant placement, incision location, and implant soaking agents. An extensive literature review of breast pocket irrigation practices was completed and used as a basis for the survey.
The survey response rate was above the ASPS average at 16% (n = 407). Respondents preferred an inframammary incision (90%) and submuscular implant placement (92%). Triple antibiotic solution (TAS) and TAS + Betadine ± Bacitracin were preferred by 61% and Betadine variants by 11%. Preferred dwell times stratified to 30 seconds (39%), 1 minute (18%), 2-5 minutes (21%), and >5 minutes (22%). Among those employing a TAS variant, 53% preferred a suboptimal dwell time of ≤1 minute. Prostheses were soaked in TAS (42%), TAS + Betadine ± Bacitracin (15%), a Betadine variant (12%), or other (31%).
Periprosthetic bacterial contamination leads to comorbidity following breast augmentation. Our results reveal significant variability regarding breast pocket irrigation techniques among ASPS members during cosmetic breast augmentation. These data suggest the need for best practice guidelines regarding breast pocket irrigation and implant soaking agents.
隆胸手术是美国最常见的手术之一。尽管乳房假体的细菌污染与不良后果相关，但对于抗菌性乳房腔隙冲洗，尚无普遍接受的指南，最佳实践建议也有限。我们设计了一项调查，以确定美国整形外科医师协会（ASPS）成员在基于植入物的隆胸手术中对腔隙冲洗的偏好和抗菌技术。
2018年1月，对2488名ASPS成员进行了随机队列调查。问题涉及乳房腔隙冲洗方法和手术技术，包括植入物放置、切口位置和植入物浸泡剂。完成了对乳房腔隙冲洗实践的广泛文献综述，并将其用作调查的基础。
调查回复率高于ASPS平均水平，为16%（n = 407）。受访者更喜欢乳房下皱襞切口（90%）和胸大肌下植入物放置（92%）。61%的人更喜欢三联抗生素溶液（TAS）和TAS + 碘伏 ± 杆菌肽，11%的人更喜欢碘伏变体。首选的停留时间分层为30秒（39%）、1分钟（18%）、2 - 5分钟（21%）和>5分钟（22%）。在使用TAS变体的人中，53%更喜欢≤1分钟的次优停留时间。假体浸泡在TAS中（42%）、TAS + 碘伏 ± 杆菌肽中（15%）、碘伏变体中（12%）或其他中（31%）。
假体周围细菌污染会导致隆胸术后出现合并症。我们的结果显示，在美容隆胸手术中，ASPS成员在乳房腔隙冲洗技术方面存在显著差异。这些数据表明需要关于乳房腔隙冲洗和植入物浸泡剂的最佳实践指南。
