I have discussed this problem with an infectious disease colleague and have some suggestions. The first thing to know is that not all MRSA's are the same. The strain that is acquired in the hospital setting (" nosocomial") is different than the ones that arise outside of this setting ("community acquired stains"). The commuinty acquired strains are sensitive to more antibiotics, making them easier to treat. Frequently these are sensitive to Ciprofloxacin (Cipro), Levoflaxacin (Levaquin), Trimethoprem/sulfamethoxazole (Bactrim), or Tetracycline which can all be administered orally. Whereas the nosocomial strain is usually only sensitve to Vancomycin, and intravenous drug.
People can be carriers for MRSA. One place that most people can easily be checked for is the nose or nasopharynx. Certainly, you shold have a nasal swab to culture for this. Also, if you have any discharge from you nipple, this also should cultured. If either of these cultures are positive, you should be treated prior to surgery. If there is a positve culture from nipple discharge, this should definitely be cleared up prior to even considering breast augmentation.
Other areas can also be sites where you can carry this bug: the axillae (armpits), and the pubic region. To treat these areas, five days prior to surgery you should wash and shower with Hibiclens, a cleanser that contains Chlorohexidine. When washing with this, you should let this dry on your skin prior to rinsing this off. This will have great effectiveness in reducing or eliminating the MRSA if you carry it in these regions. With your history, I would definitely wash with this prior to surgery.
Your surgeon should review the cultures taken when you had mastitis to determine the best antibiotic to be used at the time of surgery, and after. You will probably get different recommendations about what antibiotic to use, and how long to use it for after surgery. However, in the absence of a positive culture from the sites mentioned above, I am not sure that antibiotic therapy prior to surgery whould be recommended.
Lastly, understand that no surgery is without risks. While the incidence of infections following breast augentation are low, they still can occur. Be aware of this, and understand that you are probably at increased risk. Establish a good relationship with a board certified plastic surgeon who is thorough, and who will approach this operation with you carefully.
Good luck!
