title: In vitro and in vivo investigation of the influence of implant surface on the formation of bacterial biofilm in mammary implants.
abstract: BACKGROUND
  Capsular contracture remains the most common complication following breast augmentation surgery, and evidence suggests that bacterial biofilm on the implant surface is responsible. The authors investigated whether the interaction of bacterial biofilm with implants independently determines progression to capsule formation. They also studied the rate of bacterial growth and adhesion to implants.
  
  
  METHODS
  Sixteen adult female pigs had 121 breast implants inserted. Sixty-six implants-23 smooth and 43 textured-were inoculated with a human strain of Staphylococcus epidermidis and received no other treatment. After an average period of 19 weeks, Baker grading was performed and implants were retrieved. For the in vitro study, samples underwent both quantitative bacterial analysis and imaging using confocal laser scanning and scanning electron microscopy.
  
  
  RESULTS
  At explantation, there was no significant difference (p = 1.0) in the presence of capsular contracture (Baker grade III and IV) between smooth (83 percent) and textured implants (84 percent). Biofilm was confirmed on 60 of the 66 capsules. Capsules from smooth and textured implants had the same number of infecting bacteria (textured: 3.01 × 10 bacteria/g; smooth: 3.00 × 10 bacteria/g). In vitro, the surface of textured implants showed 11-, 43-, and 72-fold more bacteria at 2, 6, and 24 hours, respectively, compared with smooth implants (p < 0.001). These findings were confirmed by imaging analysis.
  
  
  CONCLUSIONS
  These results show that textured implants develop a significantly higher load of bacterial biofilm in comparison with smooth implants. Furthermore, in vivo, once a threshold of biofilm forms on either smooth or textured implant surfaces, there seems to be an equal propensity to progress to capsular contracture.
authors.affiliation: Sydney, New South Wales, Australia From the Surgical Infection Research Group, Australian School of Advanced Medicine, Macquarie University.
authors.forename: Anita
authors.initials: A
authors.lastname: Jacombs
authors.forename: Shamaila
authors.initials: S
authors.lastname: Tahir
authors.forename: Honghua
authors.initials: H
authors.lastname: Hu
authors.forename: Anand K
authors.initials: AK
authors.lastname: Deva
authors.forename: Ahmad
authors.initials: A
authors.lastname: Almatroudi
authors.forename: William Louis Fick
authors.initials: WLF
authors.lastname: Wessels
authors.forename: David A
authors.initials: DA
authors.lastname: Bradshaw
authors.forename: Karen
authors.initials: K
authors.lastname: Vickery
mesh_terms: D000818:Animals; D018441:Biofilms / Q000254:growth & development*; D018427:Breast Implants / Q000382:microbiology*; D005260:Female; D066298:In Vitro Techniques; D008855:Microscopy, Electron, Scanning; D011474:Prosthesis Design; D013212:Staphylococcus epidermidis / Q000502:physiology*; D013499:Surface Properties; D013552:Swine