The Efficacy of Breast Implant Irrigant Solutions: A Comparative
Analysis Using an In Vitro Model
by Ngaage, Ledibabari M.; Elegbede, Adekunle; Brao, Kristen;
Chopra, Karan; Gowda, Arvind U.; Nam, Arthur J.; Ernst, Robert K.; Shirtliff,
Mark E.; Harro, Janette; Rasko, Yvonne M.
Plastic and
Reconstructive Surgery: August 2020 -
Volume 146 - Issue 2 - p 301-308
Background:
Infections are challenging complications of implant-based
breast reconstruction and augmentation. They pose a clinical challenge, with
significant economic implications. One proposed solution is implant irrigation
at the time of placement. There is no consensus on the optimal irrigant
solution.
Methods:
The authors tested the relative efficacy of 10%
povidone-iodine, Clorpactin, Prontosan, triple-antibiotic solution, or normal
saline (negative control) against two strains each of methicillin-resistant
Staphylococcus aureus and Staphylococcus epidermidis. Sterile, smooth silicone
implant disks were immersed in irrigant solution, then incubated in suspensions
of methicillin-resistant S. aureus or S. epidermidis overnight. The disks were
rinsed and sonicated to displace adherent bacteria from the implant surface,
and the displaced bacteria were quantified. Normalized values were calculated
to characterize the relative efficacy of each irrigant.
Results:
Povidone-iodine resulted in reductions of the bacterial load
by a factor of 104 to 105 for all strains. Prontosan-treated smooth breast
implant disks had a 10-fold reduction in bacterial counts for all but one
methicillin-resistant S. aureus strain. In comparison to Prontosan,
triple-antibiotic solution demonstrated a trend of greater reduction in
methicillin-resistant S. aureus bacterial load and weaker activity against S.
epidermidis strains. Clorpactin reduced the recovered colony-forming units for
only a single strain of S. epidermidis. Povidone-iodine demonstrated the
greatest efficacy against all four strains. However, Clorpactin,
triple-antibiotic solution, and Prontosan demonstrated similar efficacies.
Conclusions:
Povidone-iodine was the most efficacious of the irrigants at
reducing methicillin-resistant S. aureus and S. epidermidis contamination.
Given the recent lifting of the U.S. Food and Drug Administration moratorium,
larger clinical studies of povidone-iodine as a breast implant irrigant
solution are warranted. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
