Capsular contracture around silicone miniimplants following bacterial contamination: an in vivo comparative experimental study between textured and polyurethane implants

Smooth versus Textured Implants and Their Association with the Frequency of Capsular Contracture in Primary Breast Augmentation

“…Because biofilm formation is also associated with BIA-ALCL, the use of textured implants carries an additional risk. 47 Lista et al compared smooth and textured implants in the subglandular plane, with a similar rate of capsular contracture. They suggest that a technique that maintains minimal bacterial contamination is more important than the implant surface.…”

An Experimental Murine Model to Assess Biofilm Persistence on Commercial Breast Implant Surfaces

“…Statistically significant differences between the bacteria adhered to smooth and macrotextured implants remained constant in the short- and long-term models, as do those observed between macrotextured and microtextured implants, adding robustness to our findings. However, the impact of these findings on capsule thickness does not apparently follow a direct relationship, as was reported in other studies [ 9 , 10 ]. The means capsule weight for each type of implant could support this lack of relation in our series.…”

Pharmacological Approaches for the Prevention of Breast Implant Capsular Contracture

“…13,14 Despite attempts by researchers to understand the mechanisms underlying CC, it is still not fully understood why inflammatory responses are sometimes so high despite the hydrophobicity of the implant surface, although the presence of biofilm is suspected. 65,80,[83][84][85][86] Also, inflammatory responses are known to be greater on hydrophobic surfaces due to the strong denaturing effect the surface exerts on adsorbed proteins; this occurs via hydrophobic interaction and is irreversible. 87 Various promising strategies to modify breast implants have been reported, including physical modification, chemical modification or incorporation and release of pharmacological agents.…”

“…98 However, in the context of CC, the biocompatibility of the implant is not the only issue that needs to be addressed; the presence of bacteria on the implant also undoubtedly induces strong inflammatory responses. 65,75,80,[83][84][85][86] Use of polypropylene meshes impregnated with the antibiotics minocycline and rifampicin drastically reduced in vivo the appearance of grade III and IV CC, even when S epidermidis was inoculated next to the implants. 99 Thus, the addition of meshes and matrices around the breast implants is now a routine strategy approach to reduce the incidence of CC, although it does require an additional component to be fitted to the implant before or during surgery.…”

“…165,166 Model silicone elastomer breast implantsdhaving their surface chemistry modified by the grafting of multiple chitosan layers and then immersed in aqueous solutions of copper acetate (containing Cu 2þ ions)dhave been shown in vitro to (i) provide controlled release of copper ions over 8 wk, (ii) reduce initial adherence of Staphylococcus epidermis to the implants (the first step in biofilm formation), and (iii) have a direct antibacterial effect 167 ; S. epidermis is widely implicated in post-operative infections and CC. 75,76,82,84,99 While this strategy is interesting and warrants further research, it would be complex, costly and impractical to implement from a commercial manufacturing perspective given the need to chemically modify the silicone elastomer surface and incorporate the copper ions.…”