Bacteria surrounding the breast implant can occur in several different forms. Of course, there are planktonic bacteria. These are the free-floating, culturable bacteria. Biofilms can then form from these and do so through several mechanisms. There's the random Brownian motion, electrostatic Van der Waals forces, and hydrogen bonding that allows planktonic bacteria to initially bind the abiotic surface of a breast implant. At the same time, during the insertion of the breast implant, inflammation occurs. This leads to the elaboration and then the deposition of extracellular matrix proteins like fibrinogen, collagens, fibronectin, as well as other proteins that can also coat the implant surface. From there, these different bacterial species and even different bacterial strains within a species can elaborate various surface molecules that enable them to anchor to the various macromolecules that are coating the breast implant. In addition to this, bacteria can also exist in other forms. Planktonic bacteria can attach to one another instead of the surface of the implant to form communities known as aggregates. These clusters may remain free-floating or eventually attached to a surface to form biofilms. Planktonic bacteria can also form agglutinates. These agglutinates exploit host factors like fibrinogen or receptors on red blood cells to form the bridges necessary for community formation. Similar to biofilms, aggregates and agglutinates provide a physical barrier that protects the bacteria against antibiotics and host immunity. But in contrast to biofilms, aggregates and agglutinates exhibit higher metabolic activity and are not initially tethered to a surface, not unlike the planktonic cells. Bacteria can also exist as dormant, solitary, antibiotic-tolerant persister cells or viable but not culturable, also known as VBNC cells.

breast implants

bacterial biofilms

inflammation

persister cells

antibiotic resistance