Sydney, New South Wales, Australia From the Surgical Infection Research Group, Australian School of Advanced Medicine, Macquarie University.
Plast Reconstr Surg. 2014 Apr;133(4):471e-480e. doi: 10.1097/PRS.0000000000000020.
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.
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.
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.
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.
包膜挛缩仍然是乳房隆乳术后最常见的并发症，有证据表明，植入物表面的细菌生物膜是其原因。作者研究了细菌生物膜与植入物的相互作用是否独立决定包膜形成的进展。他们还研究了细菌在植入物上的生长和粘附速度。
16 头成年雌性猪共植入 121 个乳房植入物。其中 66 个植入物（23 个光滑，43 个纹理）接种了人类表皮葡萄球菌（Staphylococcus epidermidis），未进行其他处理。平均 19 周后，进行贝克分级并取出植入物。在体外研究中，样本进行了定量细菌分析和共聚焦激光扫描及扫描电子显微镜成像。
在取出时，光滑（83%）和纹理（84%）植入物的包膜挛缩（贝克 3 级和 4 级）发生率无显著差异（p=1.0）。66 个包膜中有 60 个确认有生物膜。光滑和纹理植入物的包膜内细菌数量相同（纹理：3.01×10 个细菌/g；光滑：3.00×10 个细菌/g）。体外实验中，与光滑植入物相比，纹理植入物在 2、6 和 24 小时时的细菌数量分别多 11 倍、43 倍和 72 倍（p<0.001）。这些发现得到了成像分析的证实。
这些结果表明，与光滑植入物相比，纹理植入物表面会形成明显更高负荷的细菌生物膜。此外，在体内，一旦光滑或纹理植入物表面形成生物膜的阈值，似乎就有同等的包膜挛缩进展倾向。
