Detection of Subclinical Infection in Significant Breast Implant Capsules

Abstract

The pathogenesis of fibrous capsular contracture after augmentation mammaplasty is still debated. One hypothesis implicates low-grade bacterial infections as a cause. The presence of a staphylococcal biofilm in a patient with recurrent capsular contracture was previously reported. A comparative, prospective, blinded, clinical study of implants and capsules removed from patients with or without significant capsular contracture was conducted to investigate the association of biofilm contamination, breast implants, and capsular contracture. Capsule and implant samples obtained during explantation were tested by routine microbiological culture, sensitive broth culture (after maceration and sonication), and scanning electron microscopy. Clinical parameters were correlated with microbiological findings. A total of 48 implant and/or capsule samples were obtained from 27 breasts during a 22-month period. Of the 27 breasts, 19 exhibited significant contracture (Baker grade III/IV). The mean duration of implantation was 9.2 years (range, 0.4 to 26.0 years). Routine swab cultures obtained at the time of explantation were negative for bacterial growth for all samples. The sensitive broth culture technique yielded 24 positive samples (50 percent, n = 48). An analysis of capsules demonstrated that 17 of 19 samples obtained from patients with significant contracture were positive, compared with only one of eight samples obtained from patients with minimal or no contracture (p = 0.0006). Fourteen of the 17 positive cultures from significantly contracted breasts yielded coagulase-negative staphylococci, mainly, species of the Staphylococcus epidermidis group. The presence of coagulase-negative staphylococci was also significantly associated with capsular contracture (p = 0.01). There was no significant difference in the frequency of culture positivity for saline versus silicone implants (p = 0.885). Scanning electron microscopy confirmed the presence of extensive biofilm on implants and within capsules.Biofilm, in particular, S. epidermidis biofilm, was detected for a significant proportion of patients with capsular contracture. This implicates biofilm disease in the pathogenesis of contracture, and strategies for its prevention should be explored.

Bacteria detected after instrumentation surgery for pyogenic vertebral osteomyelitis in a canine model

“…Then each of the plate was placed in a sterile tube with 20 mL phosphate-buffered saline and sonicated (Branson Ultrasonic Cleaner; Branson Ultrasonics, Danbury, CT, USA) at a frequency of 50 kHz for 5 min. Previous studies [29][30][31][32][33] have proven the efficiency of such ultrasonic treatment for removing any bacteria that attach to the plates without leading to the death of bacteria. After sonication, an aliquot of the solution was collected and submitted for further microbiologic culture (n = 200 for plates) and PCR processing.…”

Using of an Alternative Testicular Prosthesis (handmade) at the Department of Urology, Hospital de Clínicas, Asunción – Paraguay School of Medical Sciences – National University of Asunción

“…Una vez pasada la pubertad se considerará plantear el cambio de esta por una que vaya en relación con el tamaño testicular del momento (17). Si el paciente se encuentra satisfecho con el tamaño de su primera prótesis, debe evitarse una nueva intervención quirúrgica (18,21).…”

Infección protésica mamaria por Mycobacteriumfortuitum en una paciente con lupus eritematoso sistémico

“…Se detectaron cultivos positivos más frecuentemente en el primer grupo (p = 0,0006) y la mayoría de los microorganismos aislados fueron Staphylococcus coagulasa negativa, principalmente S. epidermidis. La microscopia electrónica confi rmó la presencia de biopelícula en el implante y dentro de la cápsula 8 .…”