Plastic surgeons have developed a new antibiotic solution that promises to prevent the most common complication from breast implant surgery.
The formula may help reduce or eliminate a problem known as capsular contracture, or implant hardening. The condition is caused by scar tissue and can result in pain and disfigurement, interfere with mammography, and require additional surgery.
"Plastic surgeons for years have used various antibiotic solutions to irrigate the breast pockets, but no one looked at the best ones," said Dr. William P. Adams Jr., leader of the research at University of Texas Southwestern Medical Center in Dallas.
Adams and his group tested different solutions often used to irrigate breast implant pockets to find a combination that would inhibit the growth of all types of bacteria commonly associated with breast implants.
Although researchers haven't been able to clinically prove that infections causes capsular contracture, Adams said they are the prime suspect.
"We looked at different solutions and came up with the best, most optimal one for control of the bacteria," said Adams, who is also chief of plastic surgery at Parkland Memorial Hospital. The research results were published in the current issue of the Journal of Plastic and Reconstructive Surgery.
The antibiotic solution that Adams and his team developed prevented capsular contracture in all of the 125 patients studied over an 18-month period. Final analysis of the ongoing clinical study will be complete in three to five years.
The infections targeted in the project are "sub-clinical," meaning they often go unnoticed and untreated.
"It's not an infection like with a cut," Adams said. "It may not be a gross, rip-roaring infection. It may be a very indolent infection where the implant pocket gets enough colonization [of bacteria] to cause the capsular formation."
Most surgeons agree that major infections are rare.
"Having literally done thousands of [breast implants] the cases of overt infections I've seen I can count on one hand," said Dr. Joel Studin, a plastic surgeon in New York.
Surgeons use several different techniques to prevent infection.
"My experience is that a combination of two things makes a difference: One is using an antibiotic solution to irrigate the pocket, which I believe is very important," Studin said.
Another is the "no touch" technique, in which the surgeon keeps the implant from touching anything once the implant is removed from its vacuum-sealed packaging, Studin said. "In my opinion, 'no touch' definitely reduces the incidence of getting those hard scars."
More studies are needed to determine the best way to prevent complications, Adams said.
"I don't think we can say which is necessarily better," he said. "[The techniques] could be used together to get a better result. Only time will tell as we collect more clinical data using these clinical methods," he said.
In 1997, A New England Journal of Medicine study of 749 patients found that 24 percent of breast implant patients have complications including capsular contracture, implant rupture, hematoma, wound infection, and seroma.
Doctors can do better than that, Adams said. "As we understand and apply the science to implants and implant techniques and technologies, the risks and complication rates will continue to come down."
