LAUSR

This simple concept is critical to understand the nuances of device-associated infection, including capsular contracture and breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). We are honored to discuss this paper on a topic that we have had a keen interest in for over 20 years.1 This topic has been important for all breast surgeons and has continued to be, especially with the recent confirmation of the role of bacteria in BIA-ALCL.2-9 The authors have done a nice analysis in this study, and I will attempt to highlight certain portions to emphasize and sometimes clarify. The authors state, “Numerous studies and recommendations exist regarding the choice of intravenous antibiotics, timing, and duration of their administration. But the use of topical antibiotic prophylaxis agents in plastic surgery is not specified and nonstandardized.”1 We agree with this statement, but not because the details of standardization are not available. They have been readily available for the past 15 to 20 years.10-13 The problem is with surgeons inaccurately implementing these practices. With the recent developments of BIA-ALCL and the role of bacteria, surgeons have a renewed interest in minimizing bacterial load, including breast pocket irrigations. This study brings up some salient aspects of breast pocket irrigation to which we hope surgeons will finally pay attention. The authors state, “The relationship between subclinical infection and capsular contracture was confirmed in multiple studies.”1 Unfortunately, they left out the most important one. The study that had been missing for many years that proved a cause-effect of bacteria and capsular contracture.14 It is a good one for your files. The authors have detailed the specific solutions that they tested; however, I would like to clarify some of the details and historical facts. The chosen abbreviations for the solutions are also confusing, and I will detail all of them below.