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Capsular Biofilm Formation at the Interface of Textured Expanders and Human Acellular Dermal Matrix: A Comparative Scanning Electron Microscopy Study

Danino, Michel A. M.D., Ph.D.; Efanov, Johnny I. M.D.; Dimitropoulos, Georges M.D.; Moreau, Maxim Ph.D.; Maalouf, Charles M.D.; Nelea, Monica Ph.D.; Izadpanah, Ali M.D., M.Sc.; Giot, Jean-Philippe M.D.

Plastic and Reconstructive Surgery: April 2018 - Volume 141 - Issue 4 - p 919-928
doi: 10.1097/PRS.0000000000004216
Experimental: Original Articles

Background: Despite benefits in reducing capsular contractures, textured implants have been associated with significant pitfalls, such a propensity for biofilm formation. Few studies have investigated whether the use of acellular dermal matrix on textured implants produces similar findings. This study aims to characterize biofilm formation at the capsular–acellular dermal matrix interface with scanning electron microscopy.

Methods: The authors performed a prospective observational pilot study in patients undergoing two-stage expander-to-permanent implant exchange. Patients were inflated with Biocell or Siltex expanders, and specimens from the capsular-pectoralis interface and capsular–acellular dermal matrix interface were obtained and examined under scanning electron microscopy for capsular ingrowth and biofilm formation using the Van Herdeen Biofilm Grading System and the Biofilm Thickness Grading Scale.

Results: Nine patients including 14 breasts (28 capsular samples in total) were examined. Thick biofilm formation was observed in all specimens from the capsular–acellular dermal matrix interface with Biocell and 25 percent of capsule-pectoralis interface, whereas no biofilm formation was found in Siltex implants. For Biocell implants, a significant difference in biofilm coverage between the upper and lower poles was observed using the Van Herdeen Biofilm Grading System (p = 0.0028) and the Biofilm Thickness Grading Scale (p = 0.0161).

Conclusions: Biocell implants produce a significant rate of biofilm formation over acellular dermal matrix–covered capsules, which is not present in the muscular region or in Siltex implants. Further randomized controlled trials will further elucidate the clinical impact of using acellular dermal matrices with macrotextured implants.


Montreal, Quebec, Canada

From the Plastic and Reconstructive Surgery Department, Notre-Dame Hospital, University of Montreal Hospital Center.

Received for publication October 3, 2017; accepted October 18, 2017.

Presented at Plastic Surgery The Meeting 2016, Annual Meeting of the American Society of Plastic Surgeons, in Los Angeles, California, September 23 through 27, 2016.

Disclosure:Dr. Danino is a consultant and speaker for Allergan, Inc. None of the other authors has any commercial associations or financial interests to declare with respect to any of the information or products presented in this article. Operational study costs were supported in part by an Allergan, Inc., industry research grant.

Michel A. Danino, M.D., Ph.D., Notre-Dame Hospital, University of Montreal Hospital Center, 1560 Rue Sherbrooke Est, Montreal, Quebec H2L 4M1, Canada,

Copyright © 2017 by the American Society of Plastic Surgeons