There is increasing evidence that bacterial biofilm, causing a subclinical infection, is a main cause for breast implant failure presenting as capsular contracture.
Bacterial contamination during breast augmentation surgery introduces common skin flora/ bacteria into the pocket of the breast implant. The sophisticated mechanism of the bacteria enables it to form a three dimensional matrix that attaches it firmly to the implant. Once attached to the breast implant a biofilm forms, which is a polymeric matrix that prevents the bodies host defenses mechanism, antibiotics and antiseptics from eliminating the bacteria.
The continued effort of the bodies defense mechanism to eliminate the bacteria causes a chronic inflammatory state that potentially causes the fibrous tissue around the breast implant to contract causing some type of Baker I-IV capsular contracture.
Clinical studies have shown a higher grade of bacterial counts in higher grades of capsular contraction. Studies have shown significant association with S. epidermis biofilm and higher grades of capsular contracture.
During the Breast Augmentation procedure
During the breast augmentation procedure Dr. Tal Roudner performs some preventative interventions to minimize the possibility of bacterial contamination leading to formation of a biofilm and a capsular contracture.
The use of intravenous antibiotics preoperatively, careful atraumatic pocket dissection, use of a dual plane technique, use of pocket irrigation with triple-antibiotics and betadine, meticulous hemostasis, changing gloves prior to insertion of the implants, opening the implant container only right before insertion of the implant, use of the Keller funnel (introduction sleeve) when inserting the implant eliminating or minimizing any contact of the implant with the skin and gloves, minimizing manipulation of the implant after insertion, meticulous layer closure of the incisions, no drains after surgery, postoperative antibiotics, antibiotic prophylaxis that cover procedures that breach mucosal surfaces or skin.
Current ongoing investigations are evaluating the possibilities of using antibiotic impregnated/coated breast implants in the future, molecules that disrupt bacterial communication, electrical currents and Ultrasound, nanotechnology to disrupt bacterial attachments that will help reduce breast implant failure due biofilm formation.
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