Oral Presentation NZ Association of Plastic Surgeons & NZ Society for Surgery of the Hand

Tranexamic acid and antibiotics in breast implant surgery (1513)

Kelsey Ireland 1 , Rebecca McLean 1 , Emma Littlehales 1 , Bryce Jackson 1 , Howard Klein 1
  1. Cantebury District Health Board, Christchurch, CANTEBURY, New Zealand

Background: Topical antibiotic solution is commonly used in breast implant surgery to reduce the incidence of bacterial contamination and subsequent peri-implant infection. Recently, tranexamic acid (TXA) has been introduced into practice to reduce post-operative haematoma. The authors aim to confirm that the addition of topical TXA does not affect the antimicrobial activity of the standard antibiotic wash used in breast implant surgery.

Methods: An in-vitro study was carried out using six bacteria that are commonly implicated in peri-implant infections: Staphylococcus epidermidis, Staphylococcus aureus, Streptococcal pyogenes, Serratia marcescens, Cutibacterium acnes and Ralstonia mannitolilytica. A Mentor MemoryGel resteralisable gel sizer was used to create implant discs to stimulate a standard implant. Implant discs were suspended in solutions containing saline, 1g TXA, antibiotic solution (80mg gentamicin and 1g cefazolin), or both TXA and antibiotics. The discs were then transferred to bacterial solutions and incubated overnight before transfer to a phosphate-buffered saline to remove non-adherent bacteria. Sonication was carried out to disrupt bacterial biofilm that had formed on the implant disc. The sonicated fluid underwent serial dilution and was plated onto sheep blood agar and incubated overnight before plates were counted to record a colony count.

Results: No difference in colony counts were found between the two control groups (saline and TXA alone). There was a significant reduction in colony counts in both groups containing antibiotic solutions (antibiotics 96.3% reduction and TXA plus antibiotics 96.1% reduction) when compared to saline controls and TXA alone.

Discussion: With increasing use of topical TXA in breast implant surgery, further clarification of the effect of its addition on antibiotic solution and peri-implant infection rates are paramount.

Conclusions: The addition of TXA did not impact the effect of antibiotic wash using our in-vitro model. Furthermore, our model confirmed the effectiveness of antibiotic wash on reducing peri-implant bacterial growth.

  1. Weissler JM, Banuelos J, Jacobson SR, Manrique OJ, Nguyen MT, Harless CA, Tran NV, Martinez-Jorge J. Intravenous Tranexamic Acid in Implant-Based Breast Reconstruction Safely Reduces Hematoma without Thromboembolic Events. Plast Reconstr Surg. 2020 Aug;146(2):238-245. doi: 10.1097/PRS.0000000000006967. PMID: 32740567.
  2. Frois AO, Harbour PO, Azimi F, Young J, Chan B, Mak C, Warrier S. The Role of Antibiotics in Breast Pocket Irrigation and Implant Immersion: A Systematic Review. Plast Reconstr Surg Glob Open. 2018 Sep 14;6(9):e1868. doi: 10.1097/GOX.0000000000001868. PMID: 30349776; PMCID: PMC6191220.