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Sonication of Removed Breast Implants for Improved Detection of Subclinical Infection

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Abstract

Background

Capsular fibrosis is a severe complication after breast implantation with an uncertain etiology. Microbial colonization of the prosthesis is hypothesized as a possible reason for the low-grade infection and subsequent capsular fibrosis. Current diagnostic tests consist of intraoperative swabs and tissue biopsies. Sonication of removed implants may improve the diagnosis of implant infection by detachment of biofilms from the implant surface.

Methods

Breast implants removed from patients with Baker grades 3 and 4 capsular contracture were analyzed by sonication, and the resulting sonication fluid was quantitatively cultured.

Results

This study investigated 22 breast implants (6 implants with Baker 3 and 16 implants with Baker 4 capsular fibrosis) from 13 patients. The mean age of the patients was 49 years (range, 31–76 years). The mean implant indwelling time was 10.4 years (range, 3 months to 30 years). Of the 22 implants, 12 were used for breast reconstruction and 10 for aesthetic procedures. The implants were located subglandularly (n = 12), submuscularly (n = 6), and subcutaneously (n = 4). Coagulase-negative staphylococci, Propionibacterium acnes, or both were detected in the sonication fluid cultures of nine implants (41%), eight of which grew significant numbers of microorganisms (>100 colonies/ml of sonication fluid).

Conclusions

Sonication detected bacteria in 41% of removed breast implants. The identified bacteria belonged to normal skin flora. Further investigation is needed to determine any causal relation between biofilms and capsular fibrosis.

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Acknowledgments

Part of this work was presented at the Annual Meeting of the Swiss Society of Plastic Reconstructive and Aesthetic Sugery (SGPRAC) in Montreux, Switzerland, September 2007. The presentation was elected to represent Switzerland in the "Best of Europe" Session for the Annual Meeting of the European Association of Societies of Aesthetic Plastic Surgery (EASAPS).

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Authors and Affiliations

  1. Department of Plastic, Reconstructive, and Aesthetic Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland

    U. M. Rieger & G. Pierer

  2. Department of Plastic, Reconstructive, and Hand Surgery, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    U. M. Rieger & G. Pierer

  3. Plastic Surgery Unit, Crossklinik and Merian Iselin Spital, Swiss Olympic Medical Center, Föhrenstrasse 2, 4009, Basel, Switzerland

    N. J. Lüscher

  4. Division of Infectious Diseases and Hospital Epidemiology, Department of Internal Medicine, University Hospital of Basel, Petersgraben 4, 4031, Basel, Switzerland

    A. Trampuz

Authors
  1. U. M. Rieger
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  2. G. Pierer
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  3. N. J. Lüscher
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  4. A. Trampuz
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Correspondence to U. M. Rieger.

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Rieger, U.M., Pierer, G., Lüscher, N.J. et al. Sonication of Removed Breast Implants for Improved Detection of Subclinical Infection. Aesth Plast Surg 33, 404–408 (2009). https://doi.org/10.1007/s00266-009-9333-0

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  • DOI: https://doi.org/10.1007/s00266-009-9333-0

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