From the Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine.
Department of Microbiology and Molecular Genetics.
Plast Reconstr Surg. 2023 Nov 1;152(5):919e-942e. doi: 10.1097/PRS.0000000000010791. Epub 2023 Oct 23.
After studying this article, the participant should be able to: 1. Understand how bacteria negatively impact aesthetic and reconstructive breast implants. 2. Understand how bacteria infect breast implants. 3. Understand the evidence associated with common implant infection-prevention strategies, and their limitations. 4. Understand why implementation of bacteria-mitigation strategies such as antibiotic administration or "no-touch" techniques may not indefinitely prevent breast implant infection.
Bacterial infection of aesthetic and reconstructive breast implants is a common and expensive problem. Subacute infections or chronic capsular contractures leading to device explantation are the most commonly documented sequelae. Although bench and translational research underscores the complexities of implant-associated infection, high-quality studies with adequate power, control groups, and duration of follow-up are lacking. Common strategies to minimize infections use antibiotics-administered systemically, in the breast implant pocket, or by directly bathing the implant before insertion-to limit bacterial contamination. Limiting contact between the implant and skin or breast parenchyma represents an additional common strategy. The clinical prevention of breast implant infection is challenged by the clean-contaminated nature of breast parenchyma, and the variable behavior of not only specific bacterial species but also their strains. These factors impact bacterial virulence and antibiotic resistance.
学习本文后，参与者应能够：1. 了解细菌如何对美容和重建乳房植入物产生负面影响。2. 了解细菌如何感染乳房植入物。3. 了解与常见植入物感染预防策略相关的证据及其局限性。4. 了解为什么实施细菌缓解策略，如抗生素给药或“无接触”技术，可能无法无限期地预防乳房植入物感染。
美容和重建乳房植入物的细菌感染是一个常见且代价高昂的问题。亚急性感染或导致器械取出的慢性包膜挛缩是最常记录的后遗症。尽管台架和转化研究强调了与植入物相关感染的复杂性，但缺乏具有足够功率、对照组和随访时间的高质量研究。为了最大限度地减少感染，常用的策略是全身、在乳房植入物袋内或通过在插入前直接浸泡植入物给予抗生素。限制植入物与皮肤或乳房实质之间的接触是另一种常见策略。由于乳房实质的清洁污染性质以及不仅特定细菌种类而且其菌株的行为变化，乳房植入物感染的临床预防受到挑战。这些因素影响细菌的毒力和抗生素耐药性。
