Management of Biofilm with Breast Implant Surgery | Journal CME Article-Journal CME Article: Management of Biofilm with Breast Implant Surgery Video 1 of 7

Video Transcription

Understanding the relationship between bacterial infection and breast implants is important. First of all, this is an expensive problem.  In reconstructive surgery, an infection-related complication increases the cost of implant-based breast reconstruction well over $10,000.  And in addition, patients paying out of pocket for cosmetic surgery can expect to pay well over $3,000 additionally to manage infection-related complications.  Now, these complications can occur early on in the form of infection, even weeks or months after surgery, but they can also occur much later.  For example, capsular contractures can occur both in cosmetic and reconstructive implants years later, even decades later.  Just because a patient presents with a breast implant infection clinically does not necessarily mean that their cultures will be positive.  Typically, culturable bacteria are existing in their planktonic form and are more susceptible to antibiotics.  By contrast, bacterial biofilms are not typically culturable and are more resistant to antibiotics. They may be causing the infection clinically, and cultures can be negative.  A strong association between capsular contracture and bacterial biofilms on breast implants exists.  We can say that this is a causative association in an animal model where the deliberate inoculation  of breast implants with Staphylococcus epidermidis in a porcine model showed higher rates of capsular contracture.  However, in humans and in the clinical paradigm, we can say basically that there is an association.  Certainly we can show that in higher grades of capsular contracture, greater bacterial biomass can be cultured after sonication.  Capsular contracture is a main reason for why breast implants fail after primary breast augmentation.  Looking at the 10-year follow-up core studies from the three major breast implant companies, it is fairly clear that breast implants that had a smooth surface and were placed in the  subglandular plane had a higher rate of capsular contracture than all other scenarios.

Video Summary

Bacterial infections significantly impact the cost and complications of breast implants, affecting both reconstructive and cosmetic surgeries. Infections can manifest early or years later as capsular contractures, with clinical infections not always showing positive cultures. Culturable bacteria are usually more antibiotic-susceptible, while biofilms resist treatment. There's a strong association between bacterial biofilms and capsular contracture, with evidence in animal models linking biofilms to higher contracture rates. In humans, higher contracture grades are linked to more bacterial presence. Smooth, subglandular implants tend to have higher contracture rates, which is a primary reason for implant failure.

Keywords

bacterial infections

breast implants

capsular contracture

biofilms

implant failure