The following comment refers to the article entitled “Do Bacteria and Biofilm Play a Role in Double-Capsule Formation around Macrotextured Implants?” by Danino et al.1 I read this article with great interest. The authors investigated the inner capsule layer of seven double capsules formed at the interface of macrotextured breast expander implants for bacteria cell size, bacterial density, and biofilm deposition using scanning electron microscopy.
In this article, the authors concluded that biofilm may induce double-capsule formation. However, according to an article written by the same authors,2 the biofilm forms after a capsule is separated from the implant expander shell by mechanical shearing forces in accord with Hall-Findlay.3 These articles show contrary results in time sequences of biofilm and double-capsule formation. I would like to hear the authors’ explanation concerning these contrary results.
I am not sure whether we can interpret their data as supporting a hypothesis that biofilm can lead to double-capsule formation. It is hard to believe the authors’ explanation that biofilm causes double-capsule formation by affecting the immune system, weakening capsule strength, and facilitating delamination of extracellular matrix.1
Many articles related to formation of biofilm show that biofilm is found ubiquitously even in smooth-surface implants and in macrotextured implants.4,5 Considering these findings, the authors’ conclusion that biofilm is the culprit of double- capsule formation in macrotextured implants may be hasty. We need more supporting evidence to reach a conclusion concerning the role of biofilm in double-capsule formation. I would be grateful if they would share their opinions in detail.
The author has no financial conflict of interest to disclose in relation to the content of this communication.
Yeon Soo Kim, M.D., Ph.D.Department of Plastic SurgeryCatholic Kwandong University School of MedicineInternational Saint Mary’s Hospital25 Simgok-ro, 100 beon-gilSeo-gu, Incheon 404-834, Republic of Koreaplasticaa@hanmail.net
1. Danino MA, Nizard N, Paek LS, Govshievich A, Giot JP. Do bacteria and biofilm play a role in double-capsule formation around macrotextured implants? Plast Reconstr Surg. 2017;140:878883.
2. Paek LS, Giot JP, Tétreault-Paquin JO, St-Jacques S, Nelea M, Danino MA. The impact of postoperative expansion initiation timing on breast expander capsular characteristics: A prospective combined clinical and scanning electron microscopy study. Plast Reconstr Surg. 2015;135:967974.
3. Hall-Findlay EJ. Breast implant complication review: Double capsules and late seromas. Plast Reconstr Surg. 2011;127:5666.
4. Hu H, Jacombs A, Vickery K, Merten SL, Pennington DG, Deva AK. Chronic biofilm infection in breast implants is associated with an increased T-cell lymphocytic infiltrate: Implications for breast implant-associated lymphoma. Plast Reconstr Surg. 2015;135:319329.
5. Ajdic D, Zoghbi Y, Gerth D, Panthaki ZJ, Thaller S. The relationship of bacterial biofilms and capsular contracture in breast implants. Aesthet Surg J. 2016;36:297309.