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Nipple Shields in Transaxillary Breast Augmentation

Benito-Ruiz, Jesús PhD

doi: 10.1097/SAP.0000000000000895
Breast Surgery

Background Infection after breast augmentation occurs in 1.1% to 2.5% of patients. Bacterial contamination of the implants could explain some complications of breast implant surgery, including infection, capsular contracture and even anaplastic large cell lymphoma. Because of the evidence of bacterial spread from the nipple, nipple shields have been proposed as a routine maneuver to avoid contamination of the implants.

Objective To determine if nipple shields are useful in transaxillary breast augmentation.

Methods A culture was obtained from the dressing (nipple shield) in 26 patients with transaxillary incision, and follow-up lasted for 18 months. A retrospective study of patients undergoing breast augmentation between 2008 and 2012 was conducted as well to know our rate of infections. A total of 753 patients between the ages of 18 and 62 years, with a mean age of 34 years, were identified. Of these 753 patients, most underwent surgery using a transaxillary incision (72.5%). The most common placement plane was subfascial (59.2%), and in most cases, an anatomical prosthesis (78%) was used.

Results No cases of infection or capsular contracture were observed in the study group. However, 13.5% of the breasts had positive cultures of swabs taken under the nipple shields. Staphylococcus epidermidis and Enterococcus faecalis were isolated from the nipple culture. Within the retrospective study, we detected 2 cases of acute infection (0.26%) and 5 cases of late infection (0.66%). The acute infections were caused by Staphylococcus aureus. In the late infections, Pseudomonas aeruginosa was isolated in 3 cases, and S. aureus was isolated in 1 case.

Conclusions Nipple shields did not make any difference for outcomes when using the transaxillary method. Acute infections seem to occur more frequently via the areola route. Late infections seem to have a hematogenous component because an infectious background was present in all cases.

From the Private practice at Antiaging Group Barcelona, Clinica Tres Torres, Barcelona, Spain.

Received May 25, 2016, and accepted for publication, after revision July 11, 2016.

Conflicts of interest and sources of funding: none declared.

Reprints: Jesús Benito-Ruiz, PhD, c/Dr Carulla 12, 3rd floor, 08017 Barcelona, Spain. E-mail:

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