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The female breast is a hemispheric projection of variable size positioned anterior to the pectoralis major and serratus anterior muscles. A fascia layer composed of dense, irregular connective tissue connects it to these muscles.
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Nipple Shields in Transaxillary Breast Augmentation.

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Nipple shields did not prevent infections in transaxillary breast augmentation. While cultures under shields showed bacteria, infection rates remained low, suggesting other infection routes are more significant.

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Area of Science:

  • Plastic Surgery
  • Infectious Disease
  • Surgical Outcomes

Background:

  • Infection rates after breast augmentation range from 1.1% to 2.5%.
  • Bacterial contamination of implants may cause complications like infection, capsular contracture, and anaplastic large cell lymphoma.
  • Nipple shields are proposed to prevent implant contamination due to evidence of bacterial spread from the nipple.

Purpose of the Study:

  • To evaluate the efficacy of nipple shields in preventing infections during transaxillary breast augmentation.

Main Methods:

  • A prospective study involved obtaining cultures from nipple shields in 26 patients undergoing transaxillary breast augmentation.
  • A retrospective analysis of 753 breast augmentation patients (2008-2012) was performed to determine infection rates.
  • Patient data included age, incision type (72.5% transaxillary), implant placement (59.2% subfascial), and prosthesis type (78% anatomical).

Main Results:

  • No infections or capsular contractures were observed in the nipple shield group.
  • Positive bacterial cultures (Staphylococcus epidermidis, Enterococcus faecalis) were found under nipple shields in 13.5% of cases.
  • The retrospective study identified 0.26% acute infections (Staphylococcus aureus) and 0.66% late infections (Pseudomonas aeruginosa, S. aureus).

Conclusions:

  • Nipple shields showed no benefit in reducing infection or complication rates for transaxillary breast augmentation.
  • Acute infections appear to originate more commonly from the areola.
  • Late infections may have a hematogenous source, as indicated by the presence of an infectious background in all cases.