Two feared complications of breast augmentation with implants are, on the one hand, capsular fibrosis and, on the other hand, BIA – ALCL (“breast implant-associated anaplastic large cell lymphoma”), which is frequently mentioned in the media. Numerous studies have now shown that bacteria play a major role in breast implant insertion (i.e. when the implant is placed in the breast during surgery), and that the occurrence of these two complications can be reduced by minimising the presence of bacteria around the implant and during implantation.  Two American plastic surgeons – Dr. Deva and Dr. Adams – have published a 14-point plan for reducing the number of bacteria during breast augmentation, which we also follow during the procedure and would like to present to you briefly here:

• Administration of a pre-operative antibiotic – prophylaxis during the induction of anaesthesia.

We usually use the antibiotic cefuroxime (from the group of cephalosporins), which specifically targets the germ S. epidermidis. This bacterium colonises the skin + mucous membranes of humans, and is therefore frequently associated with infection in implants.

• The incision – if the anatomical conditions permit – is preferably a small incision in the crease of the lower breast.

Periareolar (around the nipple) and axillary (in the armpit) incisions are also possible (and sometimes unavoidable), but the risk of infection is increased by cutting through mammary gland tissue that is richer in bacteria.

• Use of nipple plasters to prevent secretions or milk residues and associated bacteria from leaking out.

• Dissect the tissue as atraumatically as possible to protect the blood vessels.

We always carry out the dissection with a fine needle electrode in order to protect the anatomical structures (vessels + nerves) within the breast as much as possible.

• Precise and conscientious haemostasis during the operation

• Avoidance of transection of mammary gland tissue

• Implantation of the implant submuscularly or in the so-called double layer technique.

This means that the implant has hardly any contact with the glandular tissue, which is richer in bacteria, and the risk of infection is minimised.

• Disinfection & rinsing of the implant cavity with an antibiotic or strongly bactericidal solution

• Avoiding the “skin-to-implant contact” as much as possible.

For this purpose, we use the so-called Keller funnel in our breast augmentations, and thus significantly reduce the direct contact of the implant with the skin.

• Minimising the time from opening the implant to repositioning the implant inside the breast

We hardly ever use so-called sizers (= trial implants) in our breast operations, because we have a lot of experience and with the help of new technical possibilities (such as the 3D scan), we can determine the right implant in advance – this again reduces the risk of bacteria being introduced into the operation area.

• Changing gloves before direct contact with the implant

• Avoiding the use of drains

We almost never use drains in our breast operations, because when they are removed the next day, germs could again get into the freshly operated breast.

• Multi-layer wound closure

We suture the breast in three layers during breast augmentation in order to protect the implant as well as possible from germs from the outside.

• Use of germicidal washing solutions (Octenisan – washing solution) a few days before the operation.