Management of Biofilm with Breast Implant Surgery | Journal CME Article-Journal CME Article: Management of Biofilm with Breast Implant Surgery Video 3 of 7

Video Transcription

There are many challenges in evaluating the impact of bacterial biofilms in clinical studies. Some of these include the control of covariance, for example,  the type of implant that's used, the plane of insertion, whether a mesh has been used, and then other factors that can lead to an infection like body mass  index or other factors that can lead to capsular contracture like radiation. In addition to that, there could be changes in management strategies including the  use of insertion funnels, the use of drains, and the use of systemic antibiotics, just to name a few. Another issue is the duration of follow-up. In  reconstruction studies, we know that most implant infections actually occur more than 30 days after surgery, so it's important to look at databases that  actually look at outcomes beyond 30 days, and the longer the better. And then when looking at capsular contracture rates, we know that capsular contracture  rates can continue to increase for 10 years and beyond implant insertion. This is something that the manufacturer core studies have shown us, and yet most of  the studies looking at capsular contracture in aesthetic implants have mean follow-up times of two years or less. And then another issue is the lack  of randomized prospective control studies. There are a couple of prospective randomized control studies out there in plastic surgery looking at  the use of antibiotics. However, when looking at the study that looked at breast implants and antibiotics specifically, this study is more than 20  years old and used implants that are not currently in use. And then other randomized prospective study devines didn't actually focus on breast implants,  rather including several different plastic surgery procedures. So a randomized control study looking at antibiotics and breast implants  specifically is certainly needed. And then it's also important to note that there can be variation of the host microbiome. The breast and skin  microbiome change between individuals and over time. An approach that would work well in one patient may not work that well in another. So moving  forward, we need to implement precision medicine to facilitate a more personalized approach to how and when we administer antibiotics and other  antimicrobial techniques in the breast implant patient.

Video Summary

Evaluating the impact of bacterial biofilms in clinical studies faces challenges such as controlling variables like implant type, insertion plane, and infection risks. Management strategies vary, including the use of insertion funnels and antibiotics. Follow-up duration is crucial since implant infections often occur beyond 30 days post-surgery and capsular contracture rates can increase for over a decade. Most studies, however, have shorter follow-up times. There's a shortage of randomized control studies focusing on breast implants and antibiotics, with existing studies often outdated or not implant-specific. Precision medicine is needed to tailor antimicrobial approaches for individual patients.

Keywords

bacterial biofilms

implant infections

capsular contracture

precision medicine

randomized control studies