Nipple shields and antibiotic prophylaxis in skin and nipple sparing risk reducing mastectomies—a multi-centre study

• Published in: European journal of plastic surgery Vol. 41; no. 3; pp. 307 - 310
• Main Authors: Wokes, James, Allison, K., Collis, N.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2018
• Subjects: Medicine; Medicine & Public Health; Original Paper; Plastic Surgery; Nipple shields; Antibiotics; Breast reconstruction; Implants
• ISSN: 0930-343X; 1435-0130
• DOI: 10.1007/s00238-017-1367-y

Background
Florid and sub-clinical infection in implant-based breast reconstruction can cause significant problems. There are a wide and varied range of methods utilised in an attempt to reduce infection. Nipple shields are well known to reduce the spread of infection during surgery as are prophylactic antibiotics.
Methods
Twenty patients, in two centres, had microbiological swabs taken from the nipple-areolar complex after preparation with povidone-iodine and post-operatively from the underside of nipple shields. These swabs were cultured in the local microbiology laboratory.
Results
No swabs after preparation grew organisms. Five (12.5%) swabs taken post-operatively were positive. Of these, three grew coagulase-negative Staphylococcus and two grew mixed skin commensals. All were sensitive to Flucloxacillin.
Conclusions
Nipple shields are essential to reduce the risk of infection. Povidone-iodine is satisfactory for preparation in our cohort. Prophylactic antibiotics are indicated on induction.
Level of Evidence: Level III, risk/prognostic study.