title: Role of bacterial biofilms in patients after reconstructive and aesthetic breast implant surgery.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Ulrich Michael
authors.initials: UM
authors.lastname: Rieger
authors.affiliation: Department of Cranio-Maxillofacial Surgery & Plastic Surgery, Friedrich Schiller University, Jena, Germany.
authors.forename: Gregor F
authors.initials: GF
authors.lastname: Raschke
authors.affiliation: Clinical Microbiology, Laboratory Medicine, University Hospital, Basel, Switzerland.
authors.forename: Reno
authors.initials: R
authors.lastname: Frei
authors.affiliation: 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.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Djedovic
authors.affiliation: Department of Plastic, Reconstructive & Aesthetic Surgery, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Pierer
authors.affiliation: Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Berlin, Germany.
authors.forename: Andrej
authors.initials: A
authors.lastname: Trampuz
mesh_terms: D000328:Adult; D000368:Aged; D018441:Biofilms; D019928:Breast Implantation / Q000295:instrumentation / Q000379:methods*; D018427:Breast Implants / Q000382:microbiology*; D001943:Breast Neoplasms / Q000601:surgery; D015331:Cohort Studies; D003286:Contracture / Q000382:microbiology; D020878:Device Removal; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D011425:Propionibacterium acnes; D011446:Prospective Studies; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000382:microbiology; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000382:microbiology; D015625:Tissue Expansion Devices / Q000382:microbiology