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In Vitro and In Vivo Investigation of the Influence of Implant Surface on the Formation of Bacterial Biofilm in Mammary Implants

Jacombs, Anita B.Sc.(Hons.),M.B.B.S.; Tahir, Shamaila M.B.B.S.; Hu, Honghua Ph.D.; Deva, Anand K. F.R.A.C.S.; Almatroudi, Ahmad B.Sc., M.P.H.; Wessels, William Louis Fick M.B.B.S.; Bradshaw, David A. M.B.B.S.; Vickery, Karen B.V.Sc.(Hons.), Ph.D.

Plastic and Reconstructive Surgery: April 2014 - Volume 133 - Issue 4 - p 471e–480e
doi: 10.1097/PRS.0000000000000020
Cosmetic: Original Articles

Background: Capsular contracture remains the most common complication following breast augmentation surgery, and evidence suggests that bacterial biofilm on the implant surface is responsible. The authors investigated whether the interaction of bacterial biofilm with implants independently determines progression to capsule formation. They also studied the rate of bacterial growth and adhesion to implants.

Methods: Sixteen adult female pigs had 121 breast implants inserted. Sixty-six implants—23 smooth and 43 textured—were inoculated with a human strain of Staphylococcus epidermidis and received no other treatment. After an average period of 19 weeks, Baker grading was performed and implants were retrieved. For the in vitro study, samples underwent both quantitative bacterial analysis and imaging using confocal laser scanning and scanning electron microscopy.

Results: At explantation, there was no significant difference (p = 1.0) in the presence of capsular contracture (Baker grade III and IV) between smooth (83 percent) and textured implants (84 percent). Biofilm was confirmed on 60 of the 66 capsules. Capsules from smooth and textured implants had the same number of infecting bacteria (textured: 3.01 × 108 bacteria/g; smooth: 3.00 × 108 bacteria/g). In vitro, the surface of textured implants showed 11-, 43-, and 72-fold more bacteria at 2, 6, and 24 hours, respectively, compared with smooth implants (p < 0.001). These findings were confirmed by imaging analysis.

Conclusions: These results show that textured implants develop a significantly higher load of bacterial biofilm in comparison with smooth implants. Furthermore, in vivo, once a threshold of biofilm forms on either smooth or textured implant surfaces, there seems to be an equal propensity to progress to capsular contracture.

Sydney, New South Wales, Australia

From the Surgical Infection Research Group, Australian School of Advanced Medicine, Macquarie University.

Received for publication June 20, 2013; accepted September 11, 2013.

The first two authors should be considered co–first authors.

Presented in part at the Technology in Plastic Surgery Meeting, in San Francisco, California, May 31 through June 2, 2013 and selected for presentation at The Aesthetic Meeting 2014, in San Francisco, California, April 24 through 29, 2014.

Disclosure: Dr. Deva and Dr. Vickery are consultants to Allergan, Mentor (Johnson & Johnson), and Kinetic Concepts, Inc. They have previously coordinated industry-sponsored research for these companies relating to both biofilms and breast prostheses. The remaining authors have no financial interests to disclose.

Anand K. Deva, B.Sc.(Med.), M.B.B.S., M.S., Surgical Infection Research Group, Australian School of Advanced Medicine, Macquarie University, Suite 301, 2 Technology Place, Macquarie Park, New South Wales 2109, Australia,

©2014American Society of Plastic Surgeons