Department of Plastic and Reconstructive Surgery, Guangdong Province, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou City, 510317, China.
Aesthetic Plast Surg. 2021 Aug;45(4):1451-1457. doi: 10.1007/s00266-021-02205-7. Epub 2021 Mar 12.
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.
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.
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.
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.
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包膜挛缩（Capsular contracture，CC）是乳房隆乳术的一种严重并发症和主要翻修原因。许多研究表明，在挛缩包膜中发现的大多数细菌源自皮肤，尤其是乳头乳晕复合体（nipple-areolar complex，NAC）的皮肤。为了防止植入物污染，提出了不做乳晕切口的方案，但这也成为了乳房隆乳术的一个局限性。我们旨在提出一种乳晕切口适当的皮肤管理策略，以防止植入物污染和生物膜相关的 CC。
本研究的分析基于 2017 年 2 月至 2020 年 7 月期间收集的数据。共纳入 129 例患者，随机分为两组。对照组手术前不进行皮肤处理，治疗组在 NAC 术前进行清洁和消毒。我们从对照组和治疗组收集了用于擦拭 NAC 和胸部皮肤的细菌拭子，这些拭子是在铺巾和缝合后获得的。我们评估了在拭子中检测到细菌或真菌的潜在风险，并对数据进行了分析。阳性培养率与并发症发生率之间的关系表明了我们策略的有效性。
最初获得了 774 个拭子。在对照组中，6 个拭子检测到病原体阳性，包括铺巾后 2 个 NAC 拭子检测到表皮葡萄球菌（Staphylococcus epidermidis，S. epidermidis）阳性，以及缝合后 3 个和 1 个 NAC 拭子分别检测到表皮葡萄球菌和金黄色葡萄球菌（Staphylococcus aureus，S. aureus）阳性。对照组和治疗组的其他所有样本均未检测到细菌或真菌。所有患者均至少随访 16 个月。随访期间未记录到 CC（Baker 分级 II-IV），且治疗组的结果更好，且与较小并发症的发生率较低相关。
术前适当的皮肤管理有助于保持术野无菌，潜在地防止植入物污染，甚至生物膜相关的 CC。采用这种策略，乳晕切口或任何其他入路的乳房隆乳术，甚至其他手术，都可以是一种安全的手术。
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