Sir:
We read with great interest the article entitled “The Role of Betadine Irrigation in Breast Augmentation” by Dr. Wiener.1 We are in complete agreement with the author, and we would like to draw the readers’ attention to our own work published in the Journal a few years ago.2
We were also frustrated with the U.S. Food and Drug Administration’s labeling requirement, which affected saline-filled implants as well as silicone gel implants, similar to the ones commonly used in Europe. We therefore conducted an experimental in vitro study to assess the effect of povidone iodine on the physical properties of the implant shells. Solutions of povidone iodine with concentrations ranging from 0.01% to 10% (Betadine Solution neat) were used. Our study showed that there is no effect on the mechanical properties of the implant shells from the use of povidone iodine for irrigation of the pocket or the implant itself. Although our study was performed on shells from gel-filled implants, these shells are the same as those used for saline-filled implants, and our conclusions can also be applied to those.
The issue of fibroblast toxicity by povidone iodine raised by Dr. Wiener has been the object of several studies.3–6 We would like to submit that this effect could actually be beneficial in the battle against capsular contracture. Prantl et al.7,8 showed that fibroblasts were among the main cellular populations identified histologically in breast implant capsules, and this toxicity on fibroblasts could explain why povidone iodine has been found to be one of the most effective irrigants in decreasing capsular contracture.1 Of course, further studies are warranted to identify the quantitative effect of povidone iodine on this cellular population, but we believe that this issue should be taken into consideration when discussing capsular contracture prevention.
George J. Zambacos, M.D.
Artion Plastic Surgery Center
Athens, Greece
Department of Plastic Surgery
Derriford Hospital
Plymouth, United Kingdom
Apostolos D. Mandrekas, M.D.
Artion Plastic Surgery Center
Athens, Greece
Robert J. Morris, M.D.
Department of Plastic Surgery
Derriford Hospital
Plymouth, United Kingdom
REFERENCES
1. Wiener, T. C. The role of betadine irrigation in breast augmentation.
Plast. Reconstr. Surg. 119: 12, 2007.
2. Zambacos, G. J., Nguyen, D., and Morris, R. J. Effect of povidone iodine on silicone gel breast implants in vitro: Implications for clinical practice.
Plast. Reconstr. Surg. 114: 706, 2004.
3. Zamora, J. L. Chemical and microbiologic characteristics and toxicity of povidone-iodine solutions.
Am. J. Surg. 151: 400, 1986.
4. Lineaweaver, W., Howard, R., Soucy, D., et al. Topical antimicrobial toxicity.
Arch. Surg. 120: 267, 1985.
5. Balin, A. K., and Pratt, L. Dilute povidone-iodine solutions inhibit human skin fibroblast growth.
Dermatol. Surg. 28: 210, 2002.
6. Damour, O., Hua, S. Z., Lasne, F., Villain, M., Rousselle, P., and Collombel, C. Cytotoxicity evaluation of antiseptics and antibiotics on cultured human fibroblasts and keratinocytes.
Burns 18: 479, 1992.
7. Prantl, L., Poppl, N., Horvat, N., Heine, N., and Eisenmann-Klein, M. Serologic and histologic findings in patients with capsular contracture after breast augmentation with smooth silicone gel implants: Is serum hyaluronan a potential predictor?
Aesthetic Plast. Surg. 29: 510, 2005.
8. Prantl, L., Angele, P., Schreml, S., Ulrich, D., Poppl, N., and Eisenmann-Klein, M. Determination of serum fibrosis indexes in patients with capsular contracture after augmentation with smooth silicone gel implants.
Plast. Reconstr. Surg. 118: 224, 2006.
Section Description
GUIDELINES
Letters to the Editor, discussing material recently published in the Journal, are welcome. They will have the best chance of acceptance if they are received within 8 weeks of an article’s publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters are published at the discretion of the Editor.
Authors will be listed in the order in which they appear in the submission. Letters should be submitted electronically via PRS’ enkwell, at www.editorialmanager.com/prs/.
We reserve the right to edit Letters to meet requirements of space and format. Any financial interests relevant to the content of the correspondence must be disclosed. Submission of a Letter constitutes permission for the American Society of Plastic Surgeons and its licensees and asignees to publish it in the Journal and in any other form or medium.
The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.
