The Functional Influence of Breast Implant Outer Shell Morphology on Bacterial Attachment and Growth

Abstract

Background: The introduction of texture to the outer shell of breast implants was aimed at increasing tissue incorporation and reducing capsular contracture. It has also been shown that textured surfaces promote a higher growth of bacteria and are linked to the development of breast implant–associated anaplastic large cell lymphoma. Methods: The authors aimed to measure the surface area and surface roughness of 11 available implants. In addition, the authors aimed to subject these implant shells to an in vitro bacterial attachment assay with four bacterial pathogens (Staphylococcus epidermidis, S. aureus, Pseudomonas aeruginosa, and Ralstonia pickettii) and study the relationship among surface area, surface roughness, and bacterial growth. Results: Surface area measurement showed grouping of implants into high, intermediate, low, and minimal. Surface roughness showed a correlation with surface area. The in vitro assay showed a significant linear relationship between surface area and bacterial attachment/growth. The high surface area/roughness implant texture grew significantly more bacteria at 24 hours, whereas the minimal surface area/roughness implant textures grew significantly fewer bacteria of all types at 24 hours. For implants with intermediate and low surface areas, some species differences were observed, indicating possible affinity of specific bacterial species to surface morphology. Conclusions: Implant shells should be reclassified using surface area/roughness into four categories (high, intermediate, low, and minimal). This classification is superior to the use of descriptive terms such as macrotexture, microtexture, and nanotexture, which are not well correlated with objective measurement and/or functional outcomes.

Breast implant‐associated anaplastic large cell lymphoma (BIA‐ALCL): an overview of presentation and pathogenesis and guidelines for pathological diagnosis and management

“…A significantly greater risk has been identified in association with implants with the roughest textured surface compared to those with less prominent texturing . In‐vitro bacterial attachment studies show a linear relationship between surface area/roughness and bacterial attachment/growth . Chronic inflammation due to repeated antigenic stimulation has been shown to cause T cell activation and is associated with several other T cell malignancies, and it is postulated that more sustained chronic inflammation may be mediated by the higher bacterial load associated with highly textured implants .…”

Limitaciones diagnósticas de las determinaciones inmunohistoquímicas preoperatorias en el linfoma anaplásico de células grandes asociado a implante mamario (LACG-AIM)

“…(12) Además, por parte de las empresas fabricantes y de las agencias sanitarias parece haber una tendencia a realizar modificaciones tanto en los procesos de fabricación y texturización de los implantes, como en las normativas reguladoras de estándares de nomenclatura para los mismos. (21) La paciente de nuestro caso no presentaba informes ni documentación identificativa de los implantes que portaba por lo que solo se pudo detectar la marca, volumen y tipo de cubierta durante la cirugía, siendo esos datos compatibles con los reportados en la mayoría de las publicaciones, (5,7) pero no fue posible obtener datos referentes al número de serie y otros detalles de interés de dichos implantes. Esta realidad demasiado frecuente, que dificulta entre otras cosas la recogida real de datos de los casos, debe hacernos reflexionar.…”

Aktueller Algorithmus zur Diagnostik und Therapie des Brustimplantat-assoziierten anaplastischen großzelligen Lymphoms

“…Die Oberflächenbeschaffenheit der Implantate steht dabei in direktem Bezug zur bakteriellen Besiedelung des Implantats. Studien konnten eine vermehrte bakterielle Besiedlung auf texturierten, im Vergleich zu glattwandigen Implantaten nachweisen [30,31]. Aktueller Literatur zufolge, sind sogar alle bisherigen BIA-ALCL Fälle nur bei den Patientinnen auf-getreten, die zumindest einmal texturierte Implantate implantiert hatten [24,[32][33][34].…”