Capsules, infection, and intraluminal antibiotics.

Staphylococcus epidermidis, a normal cutaneous inhabitant previously shown to be present in 67 percent of nipple secretions, has been cultured from 55 percent of surgical mammary pockets prior to implant insertion and from the interior of 71 percent of fibrous capsules explored at open capsulotomy. Cephalothin and gentamicin placed within the lumen of inflatable breast implants in vitro have been shown to diffuse outward through the silicone shell. The use of intraluminal cephalothin and gentamicin in vivo has significantly reduced our incidence of capsular contracture following both primary mammary augmentation and secondary open capsulotomy. The authors believe that the cause of fibrous capsular contracture may be a low-grade periprosthetic infection, and that the unique permeability characteristics of the silicone shell may permit sustained antimicrobial activity at the surface of the prosthesis.