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Safer Breast Implants: About the 14 Point Plan

While breast augmentation surgery is considered relatively safe, there is some risk of complications. One of the long term problems that may be associated with breast implant surgery is getting “capsular contracture,” or a painful hardening of the tissue surrounding the implant.  This can be caused by a small amount of bacterial contamination (not infection) at the time of surgery. This condition can even result in the need for implant removal and revision surgery.   To minimize the risk of capsular contracture, scientists and clinicians have devised a 14-point plan based on the latest in research. These steps can be implemented by plastic surgeons to prevent infection from occurring. The plan has received support from the world’s leading plastic surgeons since it was first published in 2013 (Deva et al.).  When considering breast augmentation surgery, make sure to inquire whether your surgeon has adopted this gold standard, 14-point plan.

Bacterial Biofilm Infections

Bacteria can exist as single organisms, where each cell functions independently of the others to survive and reproduce.  Sometimes, however, the bacteria become adherent and begin to work together, forming a “biofilm.”  This collection of bacteria secretes a sticky substance that surrounds the bacteria and help them to adhere to surfaces; the resultant coating with embedded bacteria is the biofilm.  In medical devices and implants, this biofilm can be particularly virulent and difficult to treat, creating complications for contaminated patients. It is the biofilm form of contamination that can cause capsular contracture in breast implants, which can affect one or both breasts. Because this is among the most serious problems in breast augmentation, scientists have researched mechanisms to prevent biofilm formation from occurring after surgery. The resultant 14 point plan was informed by years of scientific research to guide plastic surgeons in preventing biofilm infection for breast implant patients.

What guidelines are in the 14 point plan?

The 14-point plan is a checklist that can be employed by your surgeon and surgical staff to minimize the risk of biofilm infection. These strategies cover the duration of the surgery and include recommendations about various parts of the procedure, from start to finish.

Administer antibiotics when you begin anesthesia.  Having IV antibiotics in your body prior to incisions greatly reduces the risk of infection and contamination.  If possible, your incisions should not be made around the areola for implant placement.  Instead, incisions should be made under the breasts.  During the creation of the pocket where the implants will be placed, several guidelines should be followed to further reduce the risk of bacteria getting into the wound. For instance, the pocket should be washed with an antibacterial solution prior to implant placement. The implants themselves should be handled with new, sterile gloves, and should be placed into the pocket without making contact with the skin.  Finally, a multi-layered approach to closing the wound is also recommended.

When you choose a plastic surgeon who is fully committed to following the 14-point plan, you are minimizing the risk for bacterial infection and capsular contracture following your breast implant surgery.

The 14-point plan is an evidence-based set of recommendations for breast augmentation. At Virginia Center for Plastic Surgery, we incorporate these best practices to ensure stunning outcomes and minimal risk of complications! Call 703.884.1595 today to discover how we make your safe recovery our top priority.

Reference and Additional Information


Deva, A., Adams, W., and Vickery, K. (2013). The role of bacterial biofilms in Device-Associated Infection. Plastic and Reconstructive Surgery. 132: 1319-28.