We’ve talked about this before: one theory about why some breast implants become hard and distorted is related to a low-grade infection, called a biofilm, which triggers inflammation and fibrosis (scar tissue formation). Until now, the biofilm theory of capsular contracture was pretty much based on circumstantial evidence and by looking at similar reactions in other implants. No longer.
This month, in Plastic & Reconstructive Surgery, is a well-performed animal study from Australia that finally shows a clear link between capsule formation and a Staph. epidermidis biofilm. Miniature breast implants were implanted in a pig; some of them were purposely dosed with a low dose of the bacteria, enough to cause a biofilm, but not enough to cause outright infection. Thirteen weeks later, the animals were inspected for capsules, and a careful analysis of any capsule or biofilm found was performed.
Of the implants that had a biofilm, 80.6% formed a major capsular contracture (Baker III or IV). Statistical analysis showed that biofilm formation was associated with a four-fold increase in the risk of capsule formation.
Interestingly, a few of the implants that were not purposely inocculated with bacteria also went on to form a capsule. 80% of these also showed the presence of a biofilm. In these cases, the animal’s own skin bacteria were the biofilm-forming organisms, despite excellent surgical technique.
Bottom line: this is one of the first experimental studies that I’ve seen that clearly links biofilm with capsular contracture in a breast implantation model. We’ve certainly suspected this for a while – now we’ve got some good scientific evidence.
Now the million dollar questions: what’s the best way to minimize biofilm formation for breast implants? And how can we best treat biofilms if they’ve already become established?