Do I need to take antibiotics for urology procedures if I have breast implants?

Question

I have had previous surgeries to get rid of capsular contracture and it is finally clear. However I have to get pcnl for kidney stones which has a high infection rate . What is the chances the bacteria can seed the implant during this surgery and cause another capsular contracture. Also once the capsule is formed around the implant doesn't that prevent bacteria from entering and getting to the implant. If this can happen why are there no studies to show the correlation

Daniel Barrett, MD · Answer

Dear Imaginative153110,
every plastic surgeon has his own postoperative protocol which he recommends to his patients. I would suggest you to discuss this with your plastic surgeon.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Gerald Minniti, MD, FACS · Answer

Ideally, if your kidney surgery is not urgent, then it should be scheduled at least three months after your last capsulectomy. Regardless, bacteria can get to your implants through your capsule because the capsule is you! Filled with blood vessels that might have bacteria in it for a short period of time during and after the kidney procedure. A single dose of penicillin before surgery is sufficient to protect your implants. This should be done prior to every teeth cleaning or Pap smear as well.

Jeffrey M. Darrow, MD · Answer

Given your history, I would think it’s prudent for you to take oral antibiotics prior to your procedure on your kidney stones.  The same would be true if you’re having deep cleaning of your gums. The evidence is not conclusive, however, there is very little downside to taking a short course of antibiotics, and as you know, having to deal with your capsular contracture problem, there is a large downside to getting a new capsular contracture.  The capsule does not prevent bacteria from getting on your implant and seeding your implant even years after the capsule is fully formed as noted by women who have had implants in for years, get pregnant and breast-feed their baby and develop a mastitis in their breast. A certain percentage of these patients go onto form capsular contracture. Contact your plastic surgeon about the appropriate dosing and duration. Best wishes.

Ronald J. Edelson, MD · Answer

This is a subject that has not been studied so we don’t really know if antibiotics are needed. I would ask your urologist and plastic surgeon. Giving you antibiotics is simple enough to do if in doubt

Connie Hiers, MD, FACS · Answer

I tell my patients to take a dose of antibiotics before any procedure and before all dental appointments just to be more cautious.  Bacteria enter via the blood vessels and can get to the implant. The capsule does not always prevent this.

Camille Cash, MD · Answer

This question is best answered by your urologist and your plastic surgeon as opinions may vary.  Given your health history it may be advised to err on the side of caution.  You may be receiving antibiotics for your PCNL procedure regardless.

Mats Hagstrom, MD (license on probation) · Answer

I suggest you ask your provider.
Each plastic surgeon will have their own view on this.
Breast implants are unlikely to get contaminated from bacteremia from other procedures.
Breast implants are quite different than other foreign bodies like heart valves, which are directly in the bloodstream.
There should be no direct blood contact to your implant so bacteria are unlikely to seed the implant.
 if you are urology procedure has a high likelihood of infection and I would imagine they may have you on antibiotics anyway.
I suggest you run this by both your plastic surgeon and urologist since they are the ones making your medical decisions.
Capsular contractions due to contamination of staph. epidermidis are one reason for patients developing capsular contractions. Those who have contamination typically cannot clear the bacteria. The condition is complex difficult to assess because there is no realistic testing or treatment of the bacteria.
Best,
Mats hagstrom, MD

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