The Use of Low-Dose Chlorhexidine Gluconate Irrigation in Preventing Intraoperative Contamination in Tissue Expander-Based Breast Reconstruction.

[BACKGROUND] There are many intraoperative techniques and washes that are used to prevent bacterial contamination during breast reconstruction. Low-dose chlorhexidine gluconate (CHG) is a low-pressure irrigation that offers broad spectrum activity against microorganisms. Its use has been shown to decrease bacterial load in various implants. The aim of the study was to evaluate the ability of low-dose CHG irrigation in decreasing intraoperative bacterial detection and postoperative infections during drainless tissue expander-based breast reconstruction.

[METHODS] This is a single surgeon study including a retrospective review of patients with prepectoral drainless TE-based breast reconstructions. In breasts with CHG, breast pockets were irrigated with CHG immediately before TE placement. The TE was also soaked with CHG prior to placement. Cultures were taken from the aspiration port from the TE at the final step after closing.

[RESULTS] The study included 94 breasts from 53 patients: 52 breasts without CHG irrigation and 42 breasts with CHG irrigation. Patients with and without CHG irrigation were comparable in age and body mass index (47.2 years vs 52.4 years and 23.2 kg/m2 vs 23.3 kg/m2, P > 0.05). In breasts without CHG irrigation, 5 breasts had positive intraoperative cultures while zero breasts with CHG irrigation had positive cultures (9.6% vs 0%, P = 0.039). Bacteria detected in breasts without CHG irrigation included coagulase-negative Staphylococcus in 1 breast and Cutibacterium acnes in 4 breasts. Postoperative breast infection rate was similar between groups with 5 breast infections in both cohorts (9.6% vs 11.9%, P > 0.05).

[CONCLUSIONS] This was a pilot study comparing intraoperative culture results and postoperative infections between breasts treated with an additional low-dose CHG wash and those that did not during immediate TE-based breast reconstruction. This study provided evidence that low-dose CHG can reduce intraoperative contamination, offering objective data and insights into a potential new option to maintain, or even improve, sterility in the operating room during breast reconstruction. Although clinical infection rates remained similar between the two groups, longer follow-up time and larger sample size will provide further understanding of the role of low-dose CHG in preventing infection as well as capsular contracture.