Surgeons Discover Link between Textured Implants, Bacteria and Capsular Contracture

Breast augmentation can make you feel more confident and attractive, but there’s always been a down side to the surgery that typically affected as many as 20 to 30 percent of women with breast implants. It’s called capsular contracture or hardening of the breasts. Capsular contracture can cause pain, distortion, and can potentially lead to breast implant revision surgery. But who gets it, and why?

By Carolynn Grimes
The Plastic Surgery Channel

Leading plastic surgeons are doing extensive research in the field and have discovered some surprising results. Through specific techniques, they’ve managed to reduce the percentage of capsular contracture to as few as 2 percent. “Over the years there have been a lot of different theories of capsular contracture, and through some studies we did at UT Southwestern looking at antibiotic irrigations, we have really proven that biofilms are the primary cause,” says William P. Adams, Jr., MD from Dallas, Texas.

Dr. Adams and Dr. Anand Deva of Australia have published numerous papers and conducted clinical studies looking at ways to reduce capsular contracture. The surgeons’s study was published in the November 2013 edition of Plastic and Reconstructive Surgery. The article outlines the increasing evidence that bacterial biofilm is responsible for the failure of medical devices, leading to device-associated infection. It also details strategies in the operating room applied to combat the development of device-associated infection.

 

Specific Strategies in the Operation Room Help Reduce Infection

• Irrigating the implant and breast pocket with antibiotic solutions
• Having only one person touch the implant
• Changing surgical gloves before handling the implant
• Wiping down the skin with antibiotic solution
• Checking the pocket very precisely

“Essentially, what we’ve shown using a combination of laboratory and clinical investigations is that bacteria attach to the surface of the implant, and eventually go on to cause inflammation and contracture of the implant,” says Dr. Deva.

What’s interesting is Dr. Deva’s clinical study shows there’s a big difference in the amount of bacteria or biofilms between the two different types of implants. “The research we’ve shown is that if bacteria get exposed to the textured implant, because of the rough surface and more surface area, they tend to love growing into the nooks and crannies of the textured implant better than the smooth.” The data shows up to 72 times more bacteria can grow on the surface of a textured implant as compared to a smooth implant.

Putting Together the Puzzle of ALCL

The scientists say this may be a breakthrough to explain the puzzle of implant associated ALCL, a rare type of lymphoma. This data suggest this is a result of bacterial infection.  “I don’t want anyone to get worried because it is a rare cancer, but what we’ve shown in the research is now consistent. In the setting of the textured implant, the high numbers of bacteria lead to activation of T-cells and this chronic activation can lead, in some instances, to lymphoma,” explains Deva.

The data throws a lot of attention on the strategies in the operating room to reduce infection. Deva states, “We as surgeons have within our power to reduce the risk of bacterial contamination right at the time the implant goes into the patient.”

“What we found was, the capsular contracture rate when using these techniques, along with the specific antibiotic irrigations, was less than 2 percent. Our goal is to educate as many surgeons globally so people understand which steps can be taken to minimize the problem for patients,” says Adams.