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Updated: May 18, 2026
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Evidence-based protocol for infection control in immediate implant-based breast reconstruction
Randall O Craft1, Branimir Damjanovic, Amy S Colwell
1Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. rcraft@partners.org
Abstract:
Immediate breast implant reconstruction has among the highest incidence of infections in plastic surgery. A literature search returned key articles that showed a significant decrease in surgical-site infections by performing nasal swab evaluation to treat methicillin-sensitive and methicillin-resistant Staphylococcus aureus before surgery with mupirocin nasal ointment and 5 days of chlorhexidine scrub to the surgical area. Additional Level 1 data supported the use of chlorhexidine-alcohol over povidone-iodine solutions for skin preparation. Intraoperative data on breast pocket irrigation showed the benefits of povidone-iodine as well as a triple antibiotic solution. Nasal swabs from 120 patients showed no methicillin-resistant S. aureus but did identify 10 patients with methicillin-sensitive S. aureus, 1 with streptococcus, and 3 with gram-negative rods, which changed perioperative antibiotic management. On the basis of the previously mentioned data, an evidence-based protocol for infection control was developed to potentially decrease infection rates. Further cost and efficacy data are warranted.
Insights
Reducing surgical site infections in breast reconstruction involves nasal swabs to treat Staphylococcus aureus before surgery. Protocols using mupirocin, chlorhexidine, and specific irrigation solutions can decrease infection rates.
Area of Science:
- Plastic Surgery
- Infectious Disease Control
Background:
- Immediate breast reconstruction has high infection rates.
- Staphylococcus aureus is a common cause of surgical site infections.
Purpose of the Study:
- To evaluate an evidence-based protocol to decrease infection rates in immediate breast reconstruction.
- To assess the efficacy of nasal decolonization and specific antiseptic skin preparations.
Main Methods:
- Literature search for infection control strategies.
- Nasal swab evaluation for Staphylococcus aureus (methicillin-sensitive and methicillin-resistant strains).
- Analysis of antiseptic skin preparation and intraoperative irrigation solutions.
Main Results:
- Nasal swabs identified methicillin-sensitive S. aureus, streptococcus, and gram-negative rods in 14 of 120 patients.
- Evidence supports chlorhexidine-alcohol over povidone-iodine for skin prep.
- Povidone-iodine and triple antibiotic solutions showed benefits for breast pocket irrigation.
Conclusions:
- An evidence-based protocol incorporating nasal decolonization and optimized antiseptic use may reduce infection rates.
- Perioperative antibiotic management was altered based on nasal swab results.
- Further research on cost and efficacy is needed.
