Tag: antibiotics

Are antibiotics needed if you have breast implants for Dental Work?

Dr. Larry Nichter
Dr. Larry Nichter

This is a very controversial topic with no clear answer. To my knowledge there is not a definitive study or consensus on this topic. Here is the background information: Breast implants (and other implantable medical devices) are widely believed to increase a patient’s risk of infection or capsular contracture from bacteria entering the blood stream (oral bacteremia) and settling on the implant causing an infection or capsular contracture. As dental treatment bacteremia is a rare cause of metastatic infections it makes it difficult to attribute causality.

Some surgeons treat their patients with prophylactic oral antibiotics in the period directly after breast augmentation with breast implants as well as for any procedure that causes transient bacteria, such as dental surgery, colonoscopy, urological procedures (e.g. cystoscopy), and gynecological procedures. Probably a single dose, one hour prior to the treatment followed by single dose after the treatment should be sufficient, as long as the patient is not immunocompromised.

Whether this should be done for the first 6 months to 1 year after the breast implant placement is unclear at best. To my knowledge, there isn’t any compelling data to support this. Intuitively many surgeons treat breast implants like other implantable medical devices like pacemakers and total joint replacements.

Even vaguer is dental cleaning. One could argue that we cause a bacteremia when we simply brush our teeth and so dental cleaning is only a more aggressive cleaning. Some surgeon’s recommendations may differentiate between superficial dental cleaning (no antibiotics) and deep cleaning and periodontal treatment (antibiotics therapy). There have been anecdotal reports of infection and capsular contracture following dental treatment. Therefore some plastic surgeons and patients after considering the risk of 1–2 doses of antibiotics vs the unlikely but potentially irreparable problems with your implant is worth the risk. As there is no great answer to this controversy, my recommendation is to follow the advice of your plastic surgeon and or other members of your health care team.

Bromelain: a pineapple extract may improve post-surgery healing

Many of my patients ask about supplements that can speed the healing process. One such supplement that I feel is efficacious, decreases bruising and speeds healing is Bromelain. Below is a summary that details some of its potential beneficial qualities.

Pineapple plant. Image: Wikimedia Commons

Bromelain is a type of enzyme found in high concentrations in pineapple plants (and other plants of the plant family Bomeliaceae). Animal studies and anecdotal evidence of the medicinal properties of this pineapple plant extract have brought to light its therapeutic value. Bromelain has also been shown to have low toxicity and produces little to no undesirable side effects.

Evidence from decades of research suggests that bromelain is effective at:

  • reducing pain
  • reducing edema
  • reducing inflammation
  • improving the potency of antibiotics.

All of these properties are related to important aspects of post-operative healing.

The FDA in the United States recognizes bromelain as generally safe, and has categorized it as a food additive. It is commercially available in capsule, tablet, powder, and liquid forms for oral consumption. The recommended dosage varies between 500 to 1,500 milligrams per day.

Evidence from early studies indicate that bromelain may be an effective pain reducer. Healthy adults showed a dose-dependent response to the extract, which reduced acute knee pain and appeared to promote their general well-being. Bromelain reduced pain when applied directly to open blisters in another study.

Bromelain may reduce healing time for soft-tissue wounds. Patients in one controlled clinical trial who took Bromelain had bruising and faster reduction of edema than patients who did not. Analysis of the results, however, showed that the effect fell short of statistical significance. Results from another study showed that patients who took vitamin supplements containing Bromelain had shortened wound-healing time than those who did not.

Bromelain enhances the action of antibiotics. An early study suggested that Bromelain makes tissues more permeable to antibiotics but the results were not statistically significant. Another study, in children, found that Bromelain significantly reduced healing time for sepsis by potentiating the antibiotics.

Studies of Bromelain’s toxicity have found it to be very low. Some reports of “gastrointestinal problems, headache, tiredness, dry mouth, skin rash, and unspecified allergic reactions” have been cited as possible side effects of high doses of Bromelain. Then again, some of these symptoms are seen with placebos. Higher doses have been correlated with stronger side effects. Overall, there have been few reports of adverse effects.

Dr. Larry Nichter

More controlled clinical trials will have to return statistically significant results before Bromelain is accepted for therapeutic purposes. The extent of its efficacy and the mechanisms by which it works must be better understood. However, because of its potential, bromelain has caught the attention of the medical community and will be the object of future research.

I hope you have found this helpful and now understand why I recommend Bromelain to my patients.

—Larry S. Nichter, MD

Citations:

  • Orsini, Roger A. “Safety & Efficacy Report: Bromelain.” Plastic and Reconstructive Surgery 118.71 Dec. (2006): 1640-44. Print.