Journal time! This is out of the April 2014 issue of Plastic and Reconstructive Surgery Journal. The article is out of Australia, entitled “In Vitro and In Vivo Investigation of the Influence of Implant Surface on the Formation of Bacterial Biofilm in Mammary Implants.”
Yes, a lot to wrap your head around. In English, one of the big bad things of implants is when the capsule around them tightens or thickens, causing the breast to “turn hard.” I believe in biofilm as a cause of capsular contracture. Biofilm is a low grade colonization of bacteria, which causes chronic low grade irritation. Inflammation and irritation = thicker scar = hard breast.
This was a study done in the lab looking at breast implants inserted into pigs.
- They used smooth and textured implants
- They inoculated it with Staph Epi (a common skin bacteria)
- After 19 weeks, the did Baker capsular contracture grading and the implants were retrieved
- For the in vitro study, they looked at quantitative bacterial analysis and imaging
Findings?
- At implant removal, there was no significant difference in the presence of capsular contracture between smooth and textured implants
- biofilm was confirmed on 60 of 66 capsules
- Capsules had the same number of infecting bacteria
- In vitro, the textured implants showed much higher numbers of bacteria
So what do they think?
They conclude textured implants develop significantly higher numbers of bacterial biofilm load than smooth implants do. But once a threshold of biofilm is met, whether in smooth or textured implants, there is equal progression to capsular contracture.
What do I think?
Interesting study. I am a big believer in avoiding biofilm. The style 410 gummy bear implant is the only textured implant I use. This study did not discuss which textured implant they used, and if you have seen textured implants there is variation in the degree of texturing.
It would be interesting to redo this study in a way to see which implant gets inoculated with bacteria (which cause biofilm) more during clinical insertion of the implant.
When in actual surgery, we don’t purposefully put bacteria on an implant. We try everything we can to avoid it. I use a multitude of ways such as soaking in antibiotics, preps on the skin, IV and oral antibiotics, Keller funnels. Does the texturing of the surface affect which one “attracts” bacteria more during insertion in surgery? And the textured implants don’t work well with the Keller funnel, their pocket to place inside the breast is smaller. Does this have an effect?
We know once biofilm is established, it is almost impossible to get rid of without removing the implant and capsule. This study shows once biofilm establishes, the rates of contracture between textured and smooth are similar.
When you hear of breast implant illness, and those who feel bad from implants and feel better when they are removed, I do think biofilm and chronic inflammation could be the culprit.