Avoiding Infection at Surgical Incision Sites

Question

Hello. I am scheduled to have a breast lift within two weeks (!) and I was wondering what is the best way to avoid infection. When you check out these plastic surgery boards/forums it seems like everyone has an infection. Is it really that common? Ack!

Armando Soto, MD, FACS · Answer

Hi there-

	Your question really raises multiple issues...

	As far as infection after surgery goes, it is important to realize that it is, in fact, a risk of surgery that will never be zero. The risk can be minimized, however, by only having surgery under the most ideal circumstances, which would include:

	- You being at your healthiest

	- Having surgery performed by a Plastic Surgeon certified by The American Board of Plastic Surgery

	- In a facility certified by AAAASF or JCAHO

	Provided you ask the right questions and assure yourself of the above, your risk with the procedure you are interested in should be minimal. I can tell you that infection after a breast lift is very rare in my practice, and I know this to be the case in the practice of every other experienced and Board Certified Plastic Surgeon I know.

	As far as why there seem to be so many people on forums discussing infection, I think that there is a bit of human nature at work-

	The vast majority of happy patients- those who have a great outcome and a smooth recovery- will not go to the extra trouble it takes to post about their great outcome and experience. I can tell you this first hand- it is sometimes very difficult to get even VERY happy patients to go to the trouble of writing a testimonial....

	On the other hand, when something has not gone as smoothly as the patient was hoping, they are very interested in posting early and often. Under these circumstances, patients want to talk to others and ask if what happened to them has happened to anyone else, learn about options for making the problem better asap, and unfortunately, yes, to complain about their surgeon.

	To the extent that the internet helps us communicate and get answers when we need them, I think this can be very helpful, but when anonymous posters from miles away who are unfamiliar with the circumstances of a particular patient's problem get involved in the management of a postoperative complication, I think the web can be very counter-productive, in that it can damage the relationship the patient has with her surgeon- a relationship she needs (now more than ever) to be strong.

	So with regard to testimonials and complaints, I would advise you the way my old statistics professor used to help us navigate data:

	Throw out the best and the worst, and what's left is probably credible data.

	I hope that helps you.

David Shafer, MD, FACS · Answer

The chance of surgical infection is very low in a clean case like breast surgery. However, it is best to follow your doctor's instructions regarding pre and post op care. Also, make sure you wash your hands well and use an antibacterial gel on your hands before changing your dressings. Good luck with your surgery.

Darryl J. Blinski, MD · Answer

NO! it is not common as you state. First speak with your surgeon concerniing this issue. Second use pre operative soaps to wash daily. Third follow the post operative instructions. Fourth use local wound care as prescribed by the surgeon. Good Luck, keep us in the loop on your recovery.

	From MIAMI DR. B

Steven Wallach, MD · Answer

Actually infections arenot common after surgery. There is no specific way to avoid it, but to diminish the risk, you should shower the night before with dial soap or other products that your surgeon recommends. Also, the doctor usually prescribes antibiotics at the time of surgery and some continue them after surgery for a few days.

Peter A. Aldea, MD · Answer

It is impossible to completely abolish infections of surgical incisions.

	After the turn of the last century when surgeons began sterilizing their instruments and moved from ANTISEPTIC to ASEPTIC technique, the infection rate dropped to nearly its current level. The use of new skin penetrating surgical soaps just before surgery minimal reduced the surgical infection rate which is currently below 3% depending on the operation.

	The best way to improve your results is to have your surgery by a REAL Plastic surgeon (IE a member of The American Society of Plastic Surgeons, see www.PlasticSurgery.org ),have your surgery in a Medicare or at least AAAASF certified facility (check for yourself), not a mere office procedure room. Finally, you may want to shower using surgical soap (IE Phisohex or Hibiclens) for 2 days before your operation to lower your skin's bacterial count.

Deason Dunagan, MD (in memoriam) · Answer

As previously mentioned, infections are not that common. Avoiding infections begins with good prep before your operation, which includes showering for at least 2 to 3 days prior to the surgery with a antibacterial skin cleanser (you can use hibiclens, which is readily available at drugstore). For certain procedures, your surgeon may choose to use IV antibiotics. Post operative wound care instructions are usually very clear about keeping your incision lines clean, dry and clear of bacteria. For example children, pets and unchanged bed linens can all be potential sources of bacteria or infection that many patients don't think of. Your surgeon will be able to address any specific concerns you might have and should give you very clear instructions about how you can avoid infection.

Robert T. Buchanan, MD (retired) · Answer

Overall, the infection rate for a clean case like a breast lift is <2% in certified facilities. There are, however, a number of people doing this type of surgery in non-certified facilities, for which there are no statistics. All members of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery may do this type of surgery only in certified OR&rsquo;s. The above statistic takes into account all surgeries on all people and even superficial infections that heal rapidly.

	To reduce your risk, make sure you are on a normal diet with increased protein around the surgery and multivitamins. Also, if you have diabetes, it should be under optimal control. If you smoke, you should stop at least 6 weeks before surgery. Although there is no controlled study to prove it, most of us now ask our patients to shower well the night before and the morning of surgery with an antibacterial soap.

Avoiding Infection at Surgical Incision Sites

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