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Journal of Long-Term Effects of Medical Implants

ISSN Print: 1050-6934
ISSN Online: 1940-4379

Journal of Long-Term Effects of Medical Implants

DOI: 10.1615/JLongTermEffMedImplants.2014011206
pages 131-138

Role of Bacterial Biofilms in Patients After Reconstructive and Aesthetic Breast Implant Surgery

Ulrich M. Rieger
Department of Plastic & Aesthetic, Reconstructive & Hand Surgery, AGAPLESION Markus Hospital, Johann Wolfgang von Goethe University, Frankfurt am Main, Germany; Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Innsbruck, Austria
Gregor F. Raschke
Department of Cranio-Maxillofacial Surgery & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747 Jena, Germany
Reno Frei
Clinical Microbiology, Laboratory Medicine, University Hospital, Basel, Switzerland
Gabriel Djedovic
Department of Plastic & Aesthetic, Reconstructive & Hand Surgery, St. Markus Hospital, Johann Wolfgang von Goethe University, Germany; Department of Plastic, Reconstructive & Aesthetic Surgery, Innsbruck Medical University, Innsbruck, Austria
Gerhard Pierer
Department of Plastic, Reconstructive & Aesthetic Surgery, Innsbruck Medical University, Innsbruck, Austria; Clinical Microbiology, Laboratory Medicine, University Hospital, Basel, Switzerland
Andrej Trampuz
Center for Septic Surgery and Infectious Diseases, Center for Musculoskeletal Surgery, Charite-University Medicine Berlin, Berlin, Germany

ABSTRACT

Introduction: Capsular contracture is a feared complication following both reconstructive and aesthetic breast surgery. The etiology is uncertain, but bacterial biofilms have been suggested as trigger for chronic peri-implant inflammation, eventually leading to capsular contracture. Methods: Data were extracted from patient records included in a prospective cohort between 2008 and 2010. We compared patients who underwent submuscular breast reconstruction using expander implants and those needing implant removal for capsular contracture after aesthetic submuscular breast augmentation. Results: Of 36 included breast implants from 27 patients, 18 implants were inserted for reconstructive reasons and 18 for aesthetic reasons. The median indwelling time was 3 years for aesthetic implants and 3 months for reconstructive expanders. Overall, sonication cultures were positive in 13 implants (36%). In aesthetic implants, sonication cultures were positive in 28% and sonication cultures were positive in expander implants in 44%. Propionibacterium acnes and coagulasenegative staphylococci were predominant. Conclusion: Sonication cultures were positive in approximately 33% of removed breast implants and were comparable for reconstructive expander and aesthetic implants. These findings support the hypothesis that bacterial biofilms play a role in the pathogenesis of capsular contracture, especially after expander reconstruction, as these implants are at the highest risk of contamination during repeated implant-filling procedures.