Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug 31:2022:1389539.
doi: 10.1155/2022/1389539. eCollection 2022.

Bacitracin for Injection Recall: Impact on Immediate Breast Implant Surgical Outcomes

Abigail R Tirrell  1 , Jenna C Bekeny  2 , Eshetu A Tefera  3 , David H Song  2 , Kenneth L Fan  2
Affiliations

Bacitracin for Injection Recall: Impact on Immediate Breast Implant Surgical Outcomes

Abigail R Tirrell et al. Breast J. .

Abstract

Background: Triple-antibiotic irrigation of breast implant pockets is a mainstay of infection prophylaxis in breast reconstruction and augmentation. The recall of bacitracin for injection due to risk of anaphylaxis and nephrotoxicity in January 2020, a staple component of the irrigation solution, has raised concern for worsened postoperative sequelae. This study aimed to investigate pre- and post-recall implant-based breast surgery to analyze the impact of bacitracin in irrigation solutions on infection rates.

Methods: All implant-based breast reconstruction or augmentation surgeries from January 2019 to February 2021 were retrospectively reviewed. In a regression discontinuity study design, patients were divided into pre- and post-recall groups. Patient demographics, surgical details, and outcomes including infection rates were collected. Differences in complication rates were compared between groups and with surgical and patient factors.

Results: 254 implants in 143 patients met inclusion criteria for this study, with 172 implants placed before recall and 82 placed after recall. Patients in each cohort did not differ in age, BMI, smoking status, or history of breast radiation or capsular contracture (p > 0.05). All breast pockets were irrigated with antibiotic solution, most commonly bacitracin, cefazolin, gentamycin, and povidone-iodine before recall (116,67.4%) and cefazolin, gentamycin, and povidone-iodine after recall (59,72.0%). There was no difference in incidence of infection (6.4% vs. 8.5%, p=0.551) or cellulitis (3.5% vs. 3.7%, p=0.959) before and after recall. Implant infection was associated with smoking history (p < 0.001) and increased surgical time (p=0.003).

Conclusions: Despite the recent recall of bacitracin from inclusion in breast pocket irrigation solutions, our study demonstrated no detrimental impact on immediate complication rates. This shift in irrigation protocols calls for additional investigations into optimizing antibiotic combinations in solution, as bacitracin is no longer a viable option, to improve surgical outcomes and long-term benefits.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest.

References

    1. Song D. H., Ooi A. S. Reducing infection risk in implant-based breast-reconstruction surgery: challenges and solutions. Breast Cancer: Targets and Therapy . 2016;8:161–172. doi: 10.2147/BCTT.S97764. - DOI - PMC - PubMed
    1. Petit J. Y., Rietjens M., Garusi C. Breast reconstructive techniques in cancer patients: which ones, when to apply, which immediate and long term risks? Critical Reviews In Oncology-Hematology . 2001;38(3):231–239. doi: 10.1016/s1040-8428(00)00137-2. - DOI - PubMed
    1. Adams W. P. Capsular contracture: what is it? what causes it? how can it be prevented and managed? Clinics in Plastic Surgery . 2009;36(1):119–126. doi: 10.1016/j.cps.2008.08.007. - DOI - PubMed
    1. Adams W. P., Rios J. L., Smith S. J. Enhancing patient outcomes in aesthetic and reconstructive breast surgery using triple antibiotic breast irrigation: six-year prospective clinical study. Plastic and Reconstructive Surgery . 2006;118:46S–52S. doi: 10.1097/01.prs.0000185671.51993.7e. - DOI - PubMed
    1. Awad A. N., Heiman A. J., Patel A. Implants and breast pocket irrigation: outcomes of antibiotic, antiseptic, and saline irrigation. Aesthetic surgery journal/the American Society for Aesthetic Plastic surgery . 2022;42 doi: 10.1093/asj/sjab181/6219105. - DOI - PubMed