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~~~ Thanks Glory for picking this up and getting this discussion going. Below these two messages ~ are several studies. Thanks to all who contributed. ~~~

Subject: Re: prophylactic antibiotics with teeth cleaning ?

Date: Wed, 29 Mar 2000 21:14:20 -0600

Hi Glory,

I have had to do prophylactic antibiotics for all dental work for several years, due to my physician picking up a heart murmur nearly every time I went in for medical treatment and check-ups. My dentist didn't know about the breast implants when the heart murmur first started. However, I can now see the murmur was created by breast implant problems, which I didn't originally know I had -- 'never entered my mind, or my physicians, that my breast implants were at the root of several medical problems.

Hope this is somewhat helpful!

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Date: Thu, 30 Mar 2000 02:31:34 EST

Subject: Re: prophylactic antibiotics with teeth cleaning ?POST PLEASE

Dear Glory, I have always taken prophylactic antibiotics for any type of dental work, including cleaning. They startet it after I had the heart attack and mitral valve prolapse. I asked her, (dentist) if I would need them if I had not had the heart problems and she said that she would have required and felt strongly that I use them even with implants. Even though I no longer have the implants I still have to take them for the heart problems. I hate taking antibiotics for anything, unless deemed needed for some horrific infection, but I guess it beats the alternative!! I was on so many antibiotics, IV and oral for so long at various intervals that I really try hard to stay away from them now, unless I am sure there is no other choice!! I know that people with hip replacement and such have to take them, so it maybe, makes sense that the women who still have implants should, after all they they are a foreign body??

Speaking of Mammograms, I had one years ago, when I still had the implants and if I recall correctly, it was just a preventive thing, but can't answer that positively now!! What I do remember very well, is that it was painful, because the PS that put them in decided after I was under, that he would remove quite a bit of skin, his words, "I went ahead and did it because I did not think you would be happy with how you looked", well I think that should have been my choice entirely. What this boils down to is, I had very, very little skin to pull away from implant which cause considerable pain. At the time I remember waiting after I dressed and the radiologist called me in and was concerned about something and had one done over again. I never found out what the concern was...maybe nothing???? I do recall that it was not long after, I developed a soft lump on the implant and it turned out to be an area where the capsule had torn and some of the implant was coming through. My PS said that it was not a problem, because they were going back in again to remove scar tissue/contracture!!

I could write several pages on the problems I had with-in 10 months of getting the implants, not to mention all that went wrong during the surgery itself and the post-op recovery. I could and will say, IF ONLY, we had known something, anything, but I guess that is to late now. God bless my friend, Glory and all of you.

Much Love,

Maddy

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Author: Freedman AM; Jackson IT

Address: Section of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota.

Source: Infect Dis Clin North Am, 1989 Jun, 3:2, 275-87

Abstract: Infection following breast implants is an uncommon event. This is somewhat surprising, since the human breast is not a sterile anatomical structure. The flora found in the breast are derived from the nipple ducts and closely resemble those of normal skin. These organisms, predominantly S. epidermidis, may in some cases be responsible for firmness secondary to capsular contracture. Treatment of the periprosthetic infection usually involves implant removal, but salvage by systemic antibiotics is sometimes possible. Atypical mycobacteria are very rarely the cause of infection, but can be extremely difficult to eradicate when involved.

Toxic shock syndrome has been reported to occur following breast implants and is a life-threatening problem requiring immediate removal of the implant. It may be significant that in some cases with effusion and infection occurring many months or years after implant placement, there has been a preceding event such as a laryngitis or flu-like illness. This suggests the possibility of a bacteremia being involved in the causation of the infection.

If this were the case, then these patients should be handled in a fashion similar to those with prosthetic heart valves. Accordingly, in our own practice, we advise that penicillin "V" be given beforehand when a patient with breast implants is to have any dental procedure.

It must be stressed that there is no statistical or scientific proof at the present time that this is of any value. In conclusion, when dealing with these large foreign bodies, absolute sterility is essential, and excellent surgical technique to obviate hematoma and the occurrence of tissue ischemia is mandatory. Evidence of severe infection necessitates implant removal, but in less severe cases a trial of intravenous antibiotics is permissible. Having removed an implant, further insertion should be deferred, preferably for 6 months. If the new implant can be placed in a different plane, that is, submuscular, this is desirable. Exposed implants can be salvaged but this requires considerable judgment and one should be prepared for re-exposure or frank infection.

Author: Skoff HD

Address: Harvard Medical School, Beth Israel Hospital, Boston, Massachusetts, USA.

Source: Am J Orthop, 1997 Feb, 26:2, 145-6

Abstract: A 78-year-old woman with a silicone implant in her first carpometacarpal joint had acute inflammation and lymphangitis beginning 24 hours after a dental root canal procedure. The infection resolved after implant removal and debridement of the residual carpometacarpal space. Although this is a rare event, the use of prophylactic antibiotics to protect implants in the hand should be reviewed.

Author: Kabalin JN; Kessler R

Address: Division of Urology, Stanford University Medical Center, California.

Source: J Urol, 1988 May, 139:5, 953-5

Abstract: Penile prosthetic surgery has become an increasingly common procedure. However, infection of the prosthesis remains a significant complication that almost always results in loss of the device. We present our 10-year experience with 9 infected prostheses among 417 total penile implants, for an over-all incidence of infectious complications of 2.2 per cent.

A strict, broad-spectrum antibiotic schedule was adhered to rigidly by all patients, beginning preoperatively and continuing for a total of 10 days of perioperative coverage. Staphylococcus species were cultured in 56 per cent of the infected patients and in 100 per cent of the patients with positive cultures. Spinal cord injury patients showed a particular predisposition to prosthetic infection, with a 15 per cent incidence of infectious complications.

Two other patients became infected after dental procedures and the need for routine antibiotic prophylaxis in the penile prosthesis patient is emphasized. Urinary tract instrumentation at the time of prosthetic implantation, whether planned or incidental, also appears to add a potentially avoidable risk for subsequent infection.

LATE CLOSTRIDIUM PERFRINGENS BREAST IMPLANT INFECTION AFTER DENTAL TREATMENT

Author: Hunter JG; Padilla M; Cooper Vastola S

Address: Department of Surgery, State University of New York Health Science Center at Brooklyn, USA.

Source: Ann Plast Surg, 1996 Mar, 36:3, 309-12

Abstract: Late infection is rare after breast augmentation. Pathogenesis is usually implant seeding caused by bacteremia as a consequence of antecedent distant infections or medical/dental procedures. Reported is the first case of late implant infection, after extensive dental treatment, caused by Clostridium perfringens, an anaerobic pathogen commonly present in the human gastrointestinal tract. Prompt diagnosis and early antibiotic treatment of all bacterial infections, and serious consideration of antibiotic prophylaxis for all bacteremia-producing procedures, is essential for breast implant patients.