Triple Antibiotic Solution for Capsular Contracture
During Dr. Adams’ plastic surgery residency in the mid 90’s he became interested in breast implant research and development and capsular contracture, which for the past 60 years has been the single largest risk for breast implant based surgery. Triple Antibiotic Solution arose from a career long research focus of Dr. Adams. This solution is used in surgery to reduce the risk of capsular contracture. Patients and surgeons around the world have benefitted from this Triple Antibiotic Solution research since 1999.
Capsular contracture is a hardening of the breast that for many years had an unknown cause. In the 1990’s the subclinical infection theory gained popularity. This hypothesized that the hardening was caused by inflammation due to a colonization of bacteria around the breast implant.
Due to this theory that was championed by Boyd Burkhardt, a plastic surgeon from Arizona, surgeons typically irrigated the breast implant pockets with antibiotic irrigation solutions; however, there was no standardization in this practice as to what type of antibiotic solutions worked best. In 3 consecutive landmark publications Dr Adams was the lead author/ investigator in researching methods to optimize antibiotic irrigation practice. The study found specific antibiotic combinations were superior in broad spectrum bacterial coverage and reduction in capsular contracture. In the pivotal clinical study, using these anti-biotic irrigation techniques the capsular contracture rates were 1.8% compared to typical rates in FDA clinical trials of 10-15 % in aesthetic breast surgery and 20-30% in breast reconstruction.
Due to the findings of this study surgeons across the world have adopted these breast pocket irrigation techniques to make breast implant based procedures (both cosmetic and reconstructive) better and safer for patients.
The publication citation is:
Adams, Rios, Smith, Plast Reconstr Surg., January 2006.
Enhancing Patient Outcomes in Aesthetic and Reconstructive Breast Surgery using Triple Antibiotic Breast Irrigation – 6 years Prospective Clinical Study
Capsular contracture is a hardening of the breast due to a bacterial colonization around an implant. This causes the capsule that normally forms around the implant to gradually tighten and squeeze the implant. This can form over several months or years; a breast can change shape, harden or become painful. Severe capsular contracture is not common but it may require surgical removal of one or both breast implants.
Capsular contracture is one of Dr. Adams’ primary research focuses. He has developed several techniques to help prevent capsular contracture, and continues to develop other techniques that will hopefully minimize this risk. Dr. Adams utilizes several state of the art intra-operative techniques to help prevent this from occurring. The incidence of capsular contracture in breast implants can be quite low when specific measures are taken.
This study was the culmination of research since 1996. The original publications were in 2000 and 2001 and then in Fall/ Winter of 2005 the clinical study confirming advances in breast augmentation and breast implants for aesthetic and reconstructive breast surgery.
Capsular contracture remains to be the most common implant related complication in breast augmentation and breast lift procedures involving breast implants. Dr. Adams has published this landmark study in the January 2006 issue of Plastic and Reconstructive Surgery, the premier Plastic Surgery journal in the specialty worldwide.
“This study culminates the past 8 years of work we have done on capsular contracture and how we can make breast augmentation and breast implant procedures safer and better for patients” says Dr. Adams the Dallas based breast specialist. Dr. Adams and his colleagues have previously published recommendations to minimize capsular contracture using defined combinations of antibiotic solutions and refined techniques.
“These previous studies were in vitro (test tube) studies and the November publication reviews the 6 year clinical results in patients using these techniques,” says. Adams. “The results demonstrate that the patients in this study had a 4-5 fold lower capsular contracture rate than the best data compiled for FDA breast implant clinical trials.”
The benefits to potential patients for both aesthetic and reconstructive breast surgery are significant. The study also demonstrated that in addition to the reduction in capsular contracture the overall patient re-operation rates were 2.8% compared to 15-20% seen in PMA breast implant clinical trials over the past 2 decades. “Using these advances in breast implant patients can have better and safer results including reduced infections.”