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Microbiologic Safety of the Transareolar Approach in Breast Augmentation
Dana Mihaela Jianu1, Oana Săndulescu1, Anca Streinu-Cercel1
1Dr D.M. Jianu is a Plastic Surgeon and Associate Professor, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. Dr Săndulescu is a PhD Candidate and Assistant Lecturer, Department of Infectious Diseases, Carol Davila University of Medicine and Pharmacy; and is a Resident Physician in Infectious Diseases, Infectious Diseases Department II, National Institute for Infectious Diseases "Prof. Dr Matei Balş," Bucharest, Romania. Dr Anca Streinu-Cercel is a Lecturer, Department of Infectious Diseases, Carol Davila University of Medicine and Pharmacy. Dr Berciu is a PhD Candidate, Department of Infectious Diseases, Carol Davila University of Medicine and Pharmacy. Dr Blidaru is a Professor, Department of Oncologic Surgery, Carol Davila University of Medicine and Pharmacy. Dr Filipescu is a Senior Physician in Plastic Surgery, Dr Vartic is a Senior Physician in anesthesiology and intensive care, Dr Cobani is a Specialist Physician in Plastic and Aesthetic Surgery and Reconstructive Microsurgery, and Dr Jianu is a general surgeon, at a private medical clinic, Bucharest, Romania. Dr Tălăpan is a PhD Candidate, Department of Infectious Diseases, Carol Davila University of Medicine and Pharmacy. Dr Dorobăț is a Senior Physician in Microbiology, National Institute for Infectious Diseases "Prof. Dr Matei Balş," Bucharest, Romania. Dr Stăniceanu is a Professor, Department of Pathology, Carol Davila University of Medicine and Pharmacy. Dr Adrian Streinu-Cercel is a Professor in the Department of Infectious Diseases, Carol Davila University of Medicine and Pharmacy; Bucharest, Romania.
Background:
In aesthetic breast augmentation, especially by the transareolar approach, there is increasing concern regarding the occurrence of capsular contracture and its potential correlation with intraoperative implant contamination from putative endogenous breast flora of the nipple and lactiferous ducts. However, detectable bacteria cannot be considered synonymous with established resident microflora.
Objectives:
The authors sought to elucidate the existence of endogenous breast flora and assess the microbiologic safety of transareolar breast augmentation.
Methods:
In this prospective study (BREAST-MF), the authors collected microbiologic samples from the breast skin, ductal tissue, and parenchyma of 39 consecutive female patients who underwent breast procedures in a plastic surgery clinic. Swabs collected pre-, intra-, and postoperatively were processed for bacterial and fungal growth. Positive cultures underwent identification through VITEK and MALDI-TOF, as well as antimicrobial susceptibility testing.
Results:
Staphylococcus species accounted for 95 of 106 (89.6%) positive results from native breast skin, 15 of 18 (83.3%) positive results from decontaminated breast skin, and 4 of 4 (100%) positive results from the breast parenchyma. Methicillin resistance was present in 26.4% of S. epidermidis, 25.3% of S. hominis, and 71.4% of S. haemolyticus strains.
Conclusions:
During transareolar breast augmentation, in the nipple-areola region it is more likely to find bacteria populating the skin, rather than endogenous breast flora, as previously considered. Appropriate preoperative decontamination is essential for minimizing the risk of postoperative infections. LEVEL OF EVIDENCE 3: Risk.
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