Optimizing breast-pocket irrigation: The post-Betadine era

The practice of breast-pocket irrigation with various antibiotic solutions is supported by good literature and extensive clinical practice among most plastic surgeons. Unfortunately, recent restrictions on the use of Betadine (povidone-iodine) for breast-pocket irrigation have left many plastic surgeons confused regarding their surgical protocol for aesthetic and reconstructive breast surgery. The purpose of this study was to examine the in vitro efficacy of alternative non-Betadine-containing solutions for breast-pocket irrigation and to subsequently provide recommendations for breast-pocket irrigation in the "post-Betadine era." Bacitracin, cefazolin, gentamicin, and vancomycin were tested as single agents and in combination against organisms that have been most commonly cultured around breast implants and implicated in capsular contracture and peri-procedural infection. An established in vitro method was used for this testing. The single antibiotic agents were ineffective at controlling many of the bacteria tested. The combinations of bacitracin, cefazolin, and gentamicin, and vancomycin, cefazolin, and gentamicin both demonstrated excellent control of all the bacteria, except for allowing a 9 percent and a 6 percent growth of Pseudomonas, respectively. It was concluded that a combination breast irrigant of bacitracin, cefazolin, and gentamicin is an effective alternative to Betadine-containing breast irrigants and is recommended for clinical practice. Clinical implications are discussed in greater detail in the study.