Fillings and dental work 9 months to a year after breast augmentation.

Hello,Although I concede that there is no published data yet, I would like to make a few points why I believe it is vital to prophylax with a single dose of antibiotics prior to any non-sterile procedure, including and especially dental cleanings if you have breast implants. First, after nearly two decades of surgery, I have seen a remarkable correlation between unprotected teeth cleaning and subsequent late term capsular contracture, usually within 4 to 6 weeks. Although this is my personal anecdotal evidence, I have had discussions with other surgeons who had also seen the same thing. Second, patients with other implants, including heart valves and orthopedic devices are rigorously encouraged to prophylax prior to non-sterile procedures like teeth cleaning. Why? Because published data shows they are at risk for implant infection, which supports the notions that teeth cleanings induce a bacteremia, and that bacterial seeding can occur on implants. Third, there is a voluminous amount of data supporting the causal association between capsular contracture and bacterial contamination of breast implants, inducing a biofilm. Given this chain of logic, I have been encouraging my patients to prophylax for their lifetime, and have seen no late term contractures in patients that were compliant. I agree with one doctor that unnecessary use of antibiotics are problematic and can lead to not only serious complications, but are part of a world wide problem of bacterial drug resistance.  However, there is a big difference between taking a single dose of an antibiotic and taking a longer course.  I encourage you to continue taking a single dose of 2000 mg of amoxicillin if you are not penicillin allergic, or 1000 mg of ciprofloxicin if you are penicillin allergic. 

Thank you for your question. I would recommend speaking to your plastic surgeon about your concerns as every surgeon has their own protocols. 

Hi Ms.Confidence,Thank  you for your question.  There is certainly no literature to support the use of antibiotics with dental work, reducing the risk of capsular contraction.  Therefore, any recommendations from your surgeon is based on their experience and judgement.  Certainly I would try to avoid any elective dental work for 3-6 months after surgery, but at 1 year out it seems like this should be safe.  Of course, I defer to your surgeon's recommendations and would have this discussion with them.Hope that helps.Best,Dr. B

Thank you for sharing your question.  Each surgeon will have their own recommendations but there has not been any data to show that the antibiotics will prevent a contracture, especially in implants that have healed for nearly a year.  Hope this helps.

Thank you for your question. Every surgeon has a different opinion on this and those opinions are mostly based on anecdotal information as there is no definitive study about this. Everything in medicine has a risk/benefit ratio and you need to consider that. If the risk of an implant problem with dental work is very small, but the risk of taking antibiotics is also small, then you might take the medication. For you, if you have terrible problems with antibiotics, then you might choose to take that small risk. It is a personal decision and only you can gauge that risk/benefit ratio for yourself. Hope this helps!

Thank you for this excellent question.  The human immune system is what causes capsules to be formed around anything foreign in our bodies.  These capsules can be tight or loose depending on many factors.  Based on the information you have given us, your breasts are soft and therefore the capsules surrounding your breasts are loose at 9 months post breast augmentation.  When one has dental surgery, especially teeth cleaning, one gets blood in the mouth which opens small channels through which oral bacteria can get into our non oral tissue which then can send a message to our immune system to wall off this bacteria which is seen as an invader.  In the process of walling off this oral bacteria, the body will wall off all foreign things inside our skin.  Therefore, dental surgery can lead to a capsular contracture around such structures as artificial hips, pacemakers, and even breast implants.  As you can see this is an indirect, and not a direct relationship.Your story of antibiotics causing havoc in your system sounds to me like you may have gotten C-dif or you may be allergic to certain antibiotics.  These problems can be cleared by either your personal family practitioner or an infectious disease specialist once your gastro intestinal flora are normalized.  Taking probiotics during periods where you are taking antibiotics can obviate most gastro intestinal problems.  Also, if the problem was an allergic reaction to the antibiotics, there are many types of antibiotics which can neutralize the human mouth prior to oral surgery.In my practice, I have my patients take 2 grams of Amoxicillin one hour before the dentist.  This neutralizes the mouth.  Under these circumstances, one can lead blood in one's mouth without ever leading the the cascade causing capsular contracture.  If patients are allergic to penicillin, we substitute Cipro or another antibiotic to stand in the place of the Amoxicillin.

For many years, many Plastic Surgeons asked out post op breast implant patients to take antibiotics prior, during, and after dental work (and I still do) to prevent the possibility of capsular contraction.  Over the past 5 years, the Dental Association feels this is not needed, but I still do.  I give my patients Penicillin, 250 mg 4X/day, the day before, the day of, and the day after dental work.

but if you raise the question, it will usually be given.  As the others have said, there is no evidence to support the need for this knee jerk reaction from dentists regarding their procedures and  the need for antibiotic coverage.  But if raised, my patients will get a Rx.

Every surgeon is going to have a different opinion. Personally, at 9 months post op, I think you are fine not taking the antibiotics. Especially since they seem to be causing their own set of issues. Best of luck.

Every surgeon has a different view of this, because there is no scientific proof which way to go. My first suggestion is to try a different antibiotic. There is a known bacteremia (bacteria in the system) after dental cleaning or treatment. Normally our immune system takes care of it and we have no symptoms. The antibiotics are intended to help the immune system and avoid a biofilm (bacteria reaching the implant or capsule). We do not know if we all get bacteremia at other times or how frequently this happens because there are no symptoms. Are we protecting against something that happens only occasionally (dental treatment), when it actually happens more often? Do we even need to help the immune system in healthy people? We do not know the answers. It just seems like a good idea to help prevent capsular contracture. So I recommend prophylactic antibiotics when having dental treatment after breast implants. Still confused? So am I.