Augmentation Mammoplasty (Breast Implants) 14-Point-Plan

An important question to ask your Surgeon is whether or not they follow the 14-Point-Plan? The 14-Point-Plan is designed to minimise the number of bacteria that can contaminate breast implants at the time of surgery.  It was first published in 2013 and has since been widely adopted all around the world. Bacterial contamination of breast implants at the time of surgery has been shown to cause capsular contracture – hardening, pain and deformity following breast implant surgery.  The 14-Point-Plan outlines strategies that can be incorporated into breast implant surgery that reduce the number of bacteria that can contaminate the breast implant surface. The 14-Point-Plan includes:

  1. Use intravenous antibiotics at the start of the anaesthetic to help destroy any bacteria which might be introduced during the surgery.
  2. Avoid periareolar incisions (around the nipple); these have been shown in both laboratory and clinical studies to lead to a higher rate of contracture as the pocket dissection is contaminated directly by bacteria within the breast tissue. Similar logic could be applied to axillary incisions (in the armpit).
  3. Use nipple shields to prevent spillage of bacteria from the breast ducts into the prosthesis pocket.
  4. Perform careful atraumatic dissection to minimise damage to the breast tissue. Bacteria grow more readily on damaged tissue.
  5. Carefully stop any bleeding during surgery, to minimise blood collecting around the breast implants.
  6. Avoid cutting into the breast tissue itself. Using a submuscular, dual plane or subfascial pocket also decreases the risk of bacteria from the breast tissue coming into contact with the breast implant.
  7. Perform pocket irrigation with appropriate solutions including half strength betadine or proven antibiotics solutions.
  8. Use an introduction sleeve, so that the breast implant does not come into direct contact with the skin and its bacteria.
  9. Use new instruments and drapes, and change surgical gloves before handling the implant.
  10. Minimise the time between opening the breast implant from its sterile packaging and placing it in the anatomical pocket.
  11. Minimise repositioning and replacement of the implant.
  12. Use a layered closure.
  13. Avoid using a drainage tube, which can be a potential site of entry for bacteria.
  14. Consider the use of antibiotic prophylaxis to cover subsequent procedures that breach skin or mucosa.

By using the 14-Point-Plan, the number of bacteria attaching to implants is reduced, and the risk of breast implant complications are minimised.  These are guidelines and won’t apply to all cases.  Your specialist plastic surgeon will consider which steps apply in individual cases. By seeking out the services of a member of ASAPS who is also a Fellow of the Royal Australasian College of Surgeons (FRACS) you can be assured your surgery will be performed in a facility that is appropriately accredited for surgery, which meets the required standards of sterilisation and infection control.  In Australia, these are the National Safety and Quality Health Service Standards (NS & QHS Standards).  On this basis, patients should avoid having augmentation mammoplasty (breast implant) surgery in facilities that cannot provide evidence of meeting the NS & QHS Standards. It’s important to note that patients who have their augmentation mammoplasty (breast implant) procedure performed overseas, particularly in the developing world, are taking a significant risk as they cannot be guaranteed of the sterility standards of the facility where their procedure is to be performed.