The breast: a clean-contaminated surgical site

Area of Science:

• Microbiology
• Plastic Surgery
• Infectious Disease

Background:

• Capsular contracture is a frequent complication of breast implants.
• Subclinical infection is a suspected, yet unproven, cause of capsular contracture.

Purpose of the Study:

• To investigate the hypothesis that endogenous breast bacteria, originating from ducts near the nipple, contaminate breast implants.
• To quantify bacterial presence in different breast regions.

Main Methods:

• Twenty-five patients undergoing reduction mammaplasty provided intraoperative tissue samples from periareolar, inframammary, and axillary sites.
• Microbiological analysis quantified bacterial counts in each specimen.

Main Results:

• 38% of sampled breasts (19/50) showed positive bacterial cultures.
• Bacterial counts were significantly higher in the periareolar region compared to inframammary and axillary sites.
• Staphylococcus and Propionibacterium acnes were the most common bacteria identified, with Staphylococcus epidermidis being most prevalent.

Conclusions:

• The breast harbors significant endogenous bacteria, potentially leading to spontaneous or postoperative infections.
• High intraoperative bacterial counts suggest breast tissue harbors more bacteria than typical skin flora.
• Bacterial concentration is highest in the periareolar region, informing surgical site selection for augmentation mammaplasty.