Back to Basics: Could the Preoperative Skin Antiseptic Agent Help Prevent Biofilm-Related Capsular Contracture?

Area of Science:

• Plastic Surgery
• Infectious Disease Prevention
• Biomaterials Science

Background:

• Capsular contracture (CC) is a persistent complication in breast augmentation, strongly linked to bacterial biofilm formation.
• Over 90% of bacteria in Baker grade III-IV CC capsules are from the skin microbiome, notably Staphylococcus epidermidis.
• Preoperative skin antisepsis is crucial for minimizing implant contamination and preventing biofilm-related CC.

Purpose of the Study:

• To compare the efficacy of two antiseptic skin preparations, povidone-iodine (PVP-I) and chlorhexidine gluconate (CHG), in preventing capsular contracture (CC) after primary breast augmentation.
• To evaluate the impact of antiseptic choice on CC rates in patients undergoing periareolar breast augmentation.

Main Methods:

• A retrospective review of 63 patients undergoing primary breast augmentation via a periareolar approach in 2014.
• Patients were divided into two groups: 32 who received PVP-I antisepsis and 31 who received CHG antisepsis.
• Pearson's chi-squared test was used to compare CC proportions between the two antiseptic groups.

Main Results:

• A statistically significant difference in CC proportions was observed between the PVP-I and CHG groups.
• The incidence of capsular contracture was higher in patients prepared with PVP-I.
• No cases of capsular contracture were reported in patients whose skin was prepared with CHG.

Conclusions:

• Chlorhexidine gluconate (CHG) is more effective than povidone-iodine (PVP-I) in preventing biofilm-related capsular contracture following primary breast augmentation.
• CHG represents a superior preoperative skin antiseptic strategy for reducing CC in breast augmentation surgery.