An important question to ask your surgeon is if he follows or not the 14-steps plan?

What we´ve learned from years of studies is that bacterial contamination is the probable cause-effect of a subclinical infection and it c can be the cause of capsular contracture (hardening, pain and deformity after implant surgery), the main cause of prosthesis replacement.

And we know that this contamination can occur while doing the implant placement, and once adhered to the implant, it is virtually impossible to remove. That is the reason it is so important to avoid or at least minimize contamination of the implant during surgery.

The 14 steps plan was developed to minimize the number of bacteria that can contaminate breast implants at the time of surgery and so, it reduces the contamination, seroma, hematoma, capsular contracture and probably ALCL rates.

This plan was first published in 2013 and since then, it has been adopted in many parts of the world. The 14 steps plan outlines proven strategies which the surgeon must follow while doing a breast implant surgery, reducing the number of bacteria which can contaminate the breast implant surface.

1. Use intravenous antibiotics at the beginning of anesthesia

2. Avoid periareolar incisions (around the nipple) or through the armpit; They have been shown in clinical and laboratory studies that they lead to a higher rate of contracture and biofilm (bacterial colonization) on implants.

3. Use nipple shields to avoid spilling bacteria from the breast ducts while the implant placement.

4. Perform a carefully atraumatic dissection to decrease the breast tissue damage. The bacteria grow faster in damaged tissue.

5. Carefully stop any bleeding during the surgery to minimize blood collection around the breast implants. Blood is like food for bacteria.

6. Avoid cutting the breast tissue. The use of a submuscular pocket or a Dual Plane reduces the direct contact of the implant with the breast which is like a sponge filled with bacteria.

7. Irrigate the area with appropriate solutions, including 50% betadine solutions or tested antibiotics.

8. Use a disposable funnel introducer to prevent that the breast implant has any direct contact with the skin and bacteria that might be on it.

9. Use new instruments and retractors, and change the surgical gloves before handling the implant.

10. Minimize the time between removing the breast implant from its sterile packaging and placing it in the body.

11. Avoid tasters and putting the implant in and taking out of the skin.

12. Layer closure. The barbed sutures seal the scar.

13. Avoid, whenever possible, the use of drains, which can be a potential for bacteria to go through.

14. The use of prophylaxis with antibiotic is recommended to cover subsequent procedures that violate the skin or mucosa.