In vitro and in vivo investigation of the influence of implant surface on the formation of bacterial biofilm in mammary implants

Anita Jacombs, Shamaila Tahir, Honghua Hu, Anand K. Deva, Ahmad Almatroudi, William Louis Fick Wessels, David A. Bradshaw, Karen Vickery

Research output: Contribution to journalComment/opinionResearchpeer-review

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 ×108 bacteria/g; smooth: 3.00 ×108 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.

LanguageEnglish
Pages471e-480e
Number of pages10
JournalPlastic and reconstructive surgery
Volume133
Issue number4
DOIs
Publication statusPublished - Apr 2014

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Breast Implants
Biofilms
Contracture
Capsules
Bacteria
Bacterial Adhesion
Staphylococcus epidermidis
Bacterial Load
Electron Scanning Microscopy
Breast
Lasers
Swine
In Vitro Techniques
Growth

Cite this

Jacombs, Anita ; Tahir, Shamaila ; Hu, Honghua ; Deva, Anand K. ; Almatroudi, Ahmad ; Wessels, William Louis Fick ; Bradshaw, David A. ; Vickery, Karen. / In vitro and in vivo investigation of the influence of implant surface on the formation of bacterial biofilm in mammary implants. In: Plastic and reconstructive surgery. 2014 ; Vol. 133, No. 4. pp. 471e-480e.
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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 ×108 bacteria/g; smooth: 3.00 ×108 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.",
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In vitro and in vivo investigation of the influence of implant surface on the formation of bacterial biofilm in mammary implants. / Jacombs, Anita; Tahir, Shamaila; Hu, Honghua; Deva, Anand K.; Almatroudi, Ahmad; Wessels, William Louis Fick; Bradshaw, David A.; Vickery, Karen.

In: Plastic and reconstructive surgery, Vol. 133, No. 4, 04.2014, p. 471e-480e.

Research output: Contribution to journalComment/opinionResearchpeer-review

TY - JOUR

T1 - In vitro and in vivo investigation of the influence of implant surface on the formation of bacterial biofilm in mammary implants

AU - Jacombs,Anita

AU - Tahir,Shamaila

AU - Hu,Honghua

AU - Deva,Anand K.

AU - Almatroudi,Ahmad

AU - Wessels,William Louis Fick

AU - Bradshaw,David A.

AU - Vickery,Karen

PY - 2014/4

Y1 - 2014/4

N2 - 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 ×108 bacteria/g; smooth: 3.00 ×108 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.

AB - 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 ×108 bacteria/g; smooth: 3.00 ×108 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.

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U2 - 10.1097/PRS.0000000000000020

DO - 10.1097/PRS.0000000000000020

M3 - Comment/opinion

VL - 133

SP - 471e-480e

JO - Plastic and reconstructive surgery

T2 - Plastic and reconstructive surgery

JF - Plastic and reconstructive surgery

SN - 0032-1052

IS - 4

ER -