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The Functional Influence of Breast Implant Outer Shell Morphology on Bacterial Attachment and Growth

Jones, Phoebe, M.B.B.S.; Mempin, Maria, B.Med.Sc., M.Res.(Med.); Hu, Honghua, Ph.D.; Chowdhury, Durdana, M.B.B.S., M.Phil., Ph.D.; Foley, Matthew, Ph.D.; Cooter, Rodney, M.D.; Adams, William P. Jr, M.D.; Vickery, Karen, B.V.Sc., Ph.D.; Deva, Anand K., B.Sc.(Med.), M.B.B.S., M.S.

Plastic and Reconstructive Surgery: October 2018 - Volume 142 - Issue 4 - p 837–849
doi: 10.1097/PRS.0000000000004801
Breast: Original Articles
Journal Club
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Background: The introduction of texture to the outer shell of breast implants was aimed at increasing tissue incorporation and reducing capsular contracture. It has also been shown that textured surfaces promote a higher growth of bacteria and are linked to the development of breast implant–associated anaplastic large cell lymphoma.

Methods: The authors aimed to measure the surface area and surface roughness of 11 available implants. In addition, the authors aimed to subject these implant shells to an in vitro bacterial attachment assay with four bacterial pathogens (Staphylococcus epidermidis, S. aureus, Pseudomonas aeruginosa, and Ralstonia pickettii) and study the relationship among surface area, surface roughness, and bacterial growth.

Results: Surface area measurement showed grouping of implants into high, intermediate, low, and minimal. Surface roughness showed a correlation with surface area. The in vitro assay showed a significant linear relationship between surface area and bacterial attachment/growth. The high surface area/roughness implant texture grew significantly more bacteria at 24 hours, whereas the minimal surface area/roughness implant textures grew significantly fewer bacteria of all types at 24 hours. For implants with intermediate and low surface areas, some species differences were observed, indicating possible affinity of specific bacterial species to surface morphology.

Conclusions: Implant shells should be reclassified using surface area/roughness into four categories (high, intermediate, low, and minimal). This classification is superior to the use of descriptive terms such as macrotexture, microtexture, and nanotexture, which are not well correlated with objective measurement and/or functional outcomes.

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Sydney, New South Wales, Australia; and Dallas, Texas

From the Surgical Infection Research Group, Faculty of Medical and Health Sciences, Macquarie University; Integrated Specialist Healthcare Education and Research Foundation; Monash University; Australian Center for Microscopy and Microanalysis, University of Sydney; and the University of Texas Southwestern.

Received for publication December 28, 2017; accepted March 30, 2018.

Disclosure: Professor Deva is research coordinator and consultant to Allergan, Mentor (Johnson & Johnson), Sientra, Motiva, and Acelity. Associate Professor Vickery is research coordinator and consultant to Allergan, Mentor (Johnson & Johnson), and Acelity.

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Anand K. Deva, B.Sc.(Med.), M.B.B.S., M.S., Suite 301, 2 Technology Place, Macquarie Park, New South Wales 2109, Australia,

©2018American Society of Plastic Surgeons