Re-sterilization Prior to Implant Insertion in Prosthetic Breast Reconstruction: Is It Necessary?

Breast operations have a surgical site infection rate of <1.5%, a figure that increases to 3% after implant-based reconstructions. We aimed to assess whether contamination occurred before implant insertion and could be related to post-operative infections.

The reconstruction team prepared the surgical field using a betadine solution and standard draping. After the surgical procedures, the antiseptic was re-applied around the incision, the surgical field re-draped, and the gloves changed before implant insertion. Immediately before the betadine application and re-draping, swab cultures were collected from the peri-areolar regions and margins of the exposed field. Any signs of infection were checked during the 2-year follow-up.

A total of 164 cases were included; of these 13 showed positive swab cultures (12 of Staphylococcus epidermidis, and one of Bacillus species). Among them, only one patient developed a post-operative infection necessitating the insertion of a Hemovac drain at 42 days after a surgical procedure. Among the 151 patients with negative swab culture results, 10 patients received a diagnosis of post-operative infections; follow-up cultures primarily identified S. aureus (three methicillin-sensitive cases, four methicillin-resistant cases), whereas two were culture-negative.

Residual contamination may persist despite the initial surgical site sterilization. The re-application of antiseptics and re-draping immediately before implant insertion may help reduce post-operative infections and should be considered an adjunct to comprehensive peri-operative protocols. Some infections may be more closely related to post-operative management than pre-implant field contamination, underscoring the need for meticulous post-operative care. Definitive causal relationships should be tested using rigorously designed and adequately powered studies.