Macrotextured Breast Implants with Defined Steps to Minimize Bacterial Contamination around the Device: Experience in 42,000 Implants

William P. Adams, Eric J. Culbertson, Anand K. Deva, Mark R. Magnusson, Craig Layt, Mark L. Jewell, Patrick Mallucci, Per Heden

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Bacteria/biofilm on breast implant surfaces has been implicated in capsular contracture and breast implant-associated anaplastic large-cell lymphoma (ALCL). Macrotextured breast implants have been shown to harbor more bacteria than smooth or microtextured implants. Recent reports also suggest that macrotextured implants are associated with a significantly higher incidence of breast implant-associated ALCL. Using techniques to reduce the number of bacteria around implants, specifically, the 14-point plan, has successfully minimized the occurrence of capsular contracture. The authors hypothesize that a similar effect may be seen in reducing the risk of breast implant-associated ALCL.

Methods: Pooled data from eight plastic surgeons assessed the use of macrotextured breast implants (Biocell and polyurethane) and known cases of breast implant-associated ALCL. Surgeon adherence to the 14-point plan was also analyzed.

Results: A total of 42,035 Biocell implants were placed in 21,650 patients; mean follow-up was 11.7 years (range, 1 to 14 years). A total of 704 polyurethane implants were used, with a mean follow-up of 8.0 years (range, 1 to 20 years). The overall capsular contracture rate was 2.2 percent. There were no cases of implant-associated ALCL. All surgeons routinely performed all 13 perioperative components of the 14-point plan; two surgeons do not routinely prescribe prophylaxis for subsequent unrelated procedures.

Conclusions: Mounting evidence implicates the role of a sustained T-cell response to implant bacteria/biofilm in the development of breast implant-associated ALCL. Using the principles of the 14-point plan to minimize bacterial load at the time of surgery, the development and subsequent sequelae of capsular contracture and breast implant-associated ALCL may be reduced, especially with higher-risk macrotextured implants.

LanguageEnglish
Pages427-431
Number of pages5
JournalPlastic and reconstructive surgery
Volume140
Issue number3
DOIs
Publication statusPublished - Sep 2017

Cite this

Adams, William P. ; Culbertson, Eric J. ; Deva, Anand K. ; Magnusson, Mark R. ; Layt, Craig ; Jewell, Mark L. ; Mallucci, Patrick ; Heden, Per. / Macrotextured Breast Implants with Defined Steps to Minimize Bacterial Contamination around the Device : Experience in 42,000 Implants. In: Plastic and reconstructive surgery. 2017 ; Vol. 140, No. 3. pp. 427-431.
@article{5ed9801ccece48d086c555980f50b364,
title = "Macrotextured Breast Implants with Defined Steps to Minimize Bacterial Contamination around the Device: Experience in 42,000 Implants",
abstract = "Background: Bacteria/biofilm on breast implant surfaces has been implicated in capsular contracture and breast implant-associated anaplastic large-cell lymphoma (ALCL). Macrotextured breast implants have been shown to harbor more bacteria than smooth or microtextured implants. Recent reports also suggest that macrotextured implants are associated with a significantly higher incidence of breast implant-associated ALCL. Using techniques to reduce the number of bacteria around implants, specifically, the 14-point plan, has successfully minimized the occurrence of capsular contracture. The authors hypothesize that a similar effect may be seen in reducing the risk of breast implant-associated ALCL.Methods: Pooled data from eight plastic surgeons assessed the use of macrotextured breast implants (Biocell and polyurethane) and known cases of breast implant-associated ALCL. Surgeon adherence to the 14-point plan was also analyzed.Results: A total of 42,035 Biocell implants were placed in 21,650 patients; mean follow-up was 11.7 years (range, 1 to 14 years). A total of 704 polyurethane implants were used, with a mean follow-up of 8.0 years (range, 1 to 20 years). The overall capsular contracture rate was 2.2 percent. There were no cases of implant-associated ALCL. All surgeons routinely performed all 13 perioperative components of the 14-point plan; two surgeons do not routinely prescribe prophylaxis for subsequent unrelated procedures.Conclusions: Mounting evidence implicates the role of a sustained T-cell response to implant bacteria/biofilm in the development of breast implant-associated ALCL. Using the principles of the 14-point plan to minimize bacterial load at the time of surgery, the development and subsequent sequelae of capsular contracture and breast implant-associated ALCL may be reduced, especially with higher-risk macrotextured implants.",
author = "Adams, {William P.} and Culbertson, {Eric J.} and Deva, {Anand K.} and Magnusson, {Mark R.} and Craig Layt and Jewell, {Mark L.} and Patrick Mallucci and Per Heden",
year = "2017",
month = "9",
doi = "10.1097/PRS.0000000000003575",
language = "English",
volume = "140",
pages = "427--431",
journal = "Plastic and reconstructive surgery",
issn = "0032-1052",
publisher = "Lippincott Williams & Wilkins",
number = "3",

}

Macrotextured Breast Implants with Defined Steps to Minimize Bacterial Contamination around the Device : Experience in 42,000 Implants. / Adams, William P.; Culbertson, Eric J.; Deva, Anand K.; Magnusson, Mark R.; Layt, Craig; Jewell, Mark L.; Mallucci, Patrick; Heden, Per.

In: Plastic and reconstructive surgery, Vol. 140, No. 3, 09.2017, p. 427-431.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Macrotextured Breast Implants with Defined Steps to Minimize Bacterial Contamination around the Device

T2 - Plastic and reconstructive surgery

AU - Adams,William P.

AU - Culbertson,Eric J.

AU - Deva,Anand K.

AU - Magnusson,Mark R.

AU - Layt,Craig

AU - Jewell,Mark L.

AU - Mallucci,Patrick

AU - Heden,Per

PY - 2017/9

Y1 - 2017/9

N2 - Background: Bacteria/biofilm on breast implant surfaces has been implicated in capsular contracture and breast implant-associated anaplastic large-cell lymphoma (ALCL). Macrotextured breast implants have been shown to harbor more bacteria than smooth or microtextured implants. Recent reports also suggest that macrotextured implants are associated with a significantly higher incidence of breast implant-associated ALCL. Using techniques to reduce the number of bacteria around implants, specifically, the 14-point plan, has successfully minimized the occurrence of capsular contracture. The authors hypothesize that a similar effect may be seen in reducing the risk of breast implant-associated ALCL.Methods: Pooled data from eight plastic surgeons assessed the use of macrotextured breast implants (Biocell and polyurethane) and known cases of breast implant-associated ALCL. Surgeon adherence to the 14-point plan was also analyzed.Results: A total of 42,035 Biocell implants were placed in 21,650 patients; mean follow-up was 11.7 years (range, 1 to 14 years). A total of 704 polyurethane implants were used, with a mean follow-up of 8.0 years (range, 1 to 20 years). The overall capsular contracture rate was 2.2 percent. There were no cases of implant-associated ALCL. All surgeons routinely performed all 13 perioperative components of the 14-point plan; two surgeons do not routinely prescribe prophylaxis for subsequent unrelated procedures.Conclusions: Mounting evidence implicates the role of a sustained T-cell response to implant bacteria/biofilm in the development of breast implant-associated ALCL. Using the principles of the 14-point plan to minimize bacterial load at the time of surgery, the development and subsequent sequelae of capsular contracture and breast implant-associated ALCL may be reduced, especially with higher-risk macrotextured implants.

AB - Background: Bacteria/biofilm on breast implant surfaces has been implicated in capsular contracture and breast implant-associated anaplastic large-cell lymphoma (ALCL). Macrotextured breast implants have been shown to harbor more bacteria than smooth or microtextured implants. Recent reports also suggest that macrotextured implants are associated with a significantly higher incidence of breast implant-associated ALCL. Using techniques to reduce the number of bacteria around implants, specifically, the 14-point plan, has successfully minimized the occurrence of capsular contracture. The authors hypothesize that a similar effect may be seen in reducing the risk of breast implant-associated ALCL.Methods: Pooled data from eight plastic surgeons assessed the use of macrotextured breast implants (Biocell and polyurethane) and known cases of breast implant-associated ALCL. Surgeon adherence to the 14-point plan was also analyzed.Results: A total of 42,035 Biocell implants were placed in 21,650 patients; mean follow-up was 11.7 years (range, 1 to 14 years). A total of 704 polyurethane implants were used, with a mean follow-up of 8.0 years (range, 1 to 20 years). The overall capsular contracture rate was 2.2 percent. There were no cases of implant-associated ALCL. All surgeons routinely performed all 13 perioperative components of the 14-point plan; two surgeons do not routinely prescribe prophylaxis for subsequent unrelated procedures.Conclusions: Mounting evidence implicates the role of a sustained T-cell response to implant bacteria/biofilm in the development of breast implant-associated ALCL. Using the principles of the 14-point plan to minimize bacterial load at the time of surgery, the development and subsequent sequelae of capsular contracture and breast implant-associated ALCL may be reduced, especially with higher-risk macrotextured implants.

UR - http://www.scopus.com/inward/record.url?scp=85030621971&partnerID=8YFLogxK

U2 - 10.1097/PRS.0000000000003575

DO - 10.1097/PRS.0000000000003575

M3 - Article

VL - 140

SP - 427

EP - 431

JO - Plastic and reconstructive surgery

JF - Plastic and reconstructive surgery

SN - 0032-1052

IS - 3

ER -