Skip to main content

Subclinical infection of the silicone breast implant surface as a possible cause of capsular contracture

Aesthetic Plastic Surgery volume 16, pages 173–179 (1992)Cite this article

Abstract

In order to reexamine the possible association between bacterial presence and capsular contracture, 55 silicone devices (mammary implants or tissue expanders) were cultured at the time of their removal from 40 patients. Special culture techniques were used in an attempt to recover bacteria adhering to the smooth-surfaced implant and encased in glycocalyx biofilm. Bacteria were detected on 56% (15 of 27) of implants surrounded by contracted capsules and on 18% (5 of 28) of those without capsular contracture (p < 0.05). Only three implants tested positive using routine plating techniques. The predominant isolate was Staphylococcus epidermidis. The concept that capsular contracture is associated with subclinical infection of silicone implants is supported by this study. With changes in the microbiological technique, bacterial recovery and growth occurs at a frequency greater than previously thought.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Blecourt RA de, Wijk M van, Zeeman RJ, Posma AN: Capsular contracture after augmentation mammaplasty: A retrospective study. Eur J Plast Surg 12:83, 1989

    Google Scholar 

  2. Bostwick J: Plastic and reconstructive breast surgery. St. Louis: Quality Medical Publishing, 1990, p 181

    Google Scholar 

  3. Brody GS, Latts JR: Discussion. Plast Reconstr Surg 68:48, 1981

    Google Scholar 

  4. Buret A, Ward KH, Olson ME, Costerton JW: An in vivo model to study the pathobiology of infectious biofilms on biomaterial surfaces. Biomed Mat Res 25:865, 1991

    Google Scholar 

  5. Burkhardt B: Comparing contracture rates: probability theory and the unilateral contracture. Plast Reconstr Surg 74:527, 1984

    Google Scholar 

  6. Burkhardt B: Fibrous capsular contracture around breast implants: the role of subclinical infection. Infect Surg 4:469, 1985

    Google Scholar 

  7. Burkhardt B, Dempsey PD, Schnur PL, Tofield JJ: Capsular contracture: a prospective study of the effect of local antibacterial agents. Plast Reconstr Surg 77:919, 1986

    Google Scholar 

  8. Burkhardt B, Fried M, Schnur PL, Tofield JJ: Capsules, infection and intraluminal antibiotics. Plast Reconstr Surg 68:43, 1981

    Google Scholar 

  9. Christensen GD, Simpson WA, Bisno AL, Beachey EH: Adherence of slime-producing strains of Staphylococcus epidermidis to smooth surfaces. Infect Immun 37:318, 1982

    Google Scholar 

  10. Chuard C, Lucet JL, Rohner P, Herrmann M, Auckenthaler R, Waldvogel FA, Lew DP: Resistance of Staphylococcus aureus recovered from infected for eign body in vivo to killing by antimicrobials. J Infect Dis 163:1369, 1991

    Google Scholar 

  11. Courtiss EH, Goldwyn RM, Anastazi GW: The fate of breast implants with infections around them. Plast Reconstr Surg 63:812, 1979

    Google Scholar 

  12. Edberg SC: Methods of quantitative microbiological analyses that support the diagnosis, treatment and prognosis of human infection. CRC Crit Rev Microbiol 8:339, 1981

    Google Scholar 

  13. Evans RC, Holmes CJ: Effect of vancomycin hydrochloride on Staphylococcus epidermidis biofilm associated with silicone elastomer. Antimicrob Agents Chemother 31:889, 1987

    Google Scholar 

  14. Freedman A, Jackson IT: Infections in breast implants. Infect Dis Clin N Am 3:275, 1989

    Google Scholar 

  15. Gibson-d'Ambrosio RE, Samuel M, d'Ambrosio SM: A method for isolating large numbers of viable disaggregated cells from various human tissue for cell culture establishment. In Vitro Cell Develop Biol 22:529, 1986

    Google Scholar 

  16. Gray ED, Peters G, Verstegen M, Regelman WE: Effect of extracellular slime substance from Staphylococcus epidermidis on the human cellular immune response. Lancet 1:365, 1984

    Google Scholar 

  17. Gylbert L, Asplund O, Berggren A, Jurell G, Ransjo U, Ostrup L: Preoperative antibiotics and capsular contracture in augmentation mammaplasty. Plast Reconstr Surg 86:260, 1990

    Google Scholar 

  18. Kalman PG, Ward CA, McKeown NB, McCullough D, Romaschin AD: Improved biocompatability of silicone rubber by removal of surface entrapped air nuclei. Biomed Mat Res 25:199, 1991

    Google Scholar 

  19. Lewis DL, Pope JD, Gattie DK, Said WA: Laboratory procedure for determining substrate removal rate coefficients for biofilms. J Microbiol Meth 10:103, 1989

    Google Scholar 

  20. Loosdrecht MCH van, Lyklema J, Norde W, Zehnder AJB: Influence of interfaces on microbial activity. Microbiol Rev 54:75, 1990

    Google Scholar 

  21. Marrie TJ, Costerton JW: Scanning and transmission microscopy of in situ bacterial colonization of intravenous and intraarterial catheters. J Clin Microbiol 19:687, 1984

    Google Scholar 

  22. Mattila T: A staining technique to measure capsular polysaccharides of Staphylococcus aureus on filter membrane. J Microbiol Meth 9:323, 1989

    Google Scholar 

  23. McCauley RL, Riley WB, Juliano RA, Brown P, Evans MJ, Robson MC: In vitro alterations in human fibroblast behaviour secondary to silicone polymers. J Surg Res 49:103, 1990

    Google Scholar 

  24. Miller S: Discussion. Plast Reconstr Surg 68:39, 1981

    Google Scholar 

  25. Neerven ARW van, Wijfels RH, Zehnder AJB: Scanning electron microscopy of immobilized bacteria in gel beads: a comparative study of fixation methods. J Microbiol Meth 11:157, 1990

    Google Scholar 

  26. Nickel JC, Heaton J, Morales A, Costerton JW: Bacterial biofilm in persistent penile prosthesis—associated infection. J Urol 135:586, 1986

    Google Scholar 

  27. Olesen LL, Ejlertsen T, Nielsen J: Toxic shock syndrome following insertion of breast prosthesis Br J Surg 78:585, 1991

    Google Scholar 

  28. Parvis U, Sharpe AN, Bergener DM, Lachapelle G, Milling M, Sipiring F: Comparison of bacterial counts obtained from naturally contaminated foods by means of Stomacher Lab blender. Can J Microbiol 33:52, 1987

    Google Scholar 

  29. Pfaller MA, Herwaldt LA: Laboratory, clinical, and epidemiological aspects of coagulase-negative Staphylococci. Clin Microbiol Rev 1:281, 1988

    Google Scholar 

  30. Roszak DB, Colwell RR: Survival strategies of bacteria in the natural environment. Microbiol Rev 51:365, 1987

    Google Scholar 

  31. Rudolph R, Woodward M: Absence of visible bacteria in capsules around silicone breast implants. Plast Reconstr Surg 72:32, 1983

    Google Scholar 

  32. Sanger JR, Sheth NK, Franson TR: Adherence of microorganisms to breast prostheses: an in vitro study. Ann Plast Surg 22:337, 1989

    Google Scholar 

  33. Sutherland IW: Microbial exopolysaccarides-their role in microbial adhesion in aqueous systems. CRC Crit Rev Microbiol 10:173, 1983

    Google Scholar 

  34. Shah Z, Lehman JA, Tan J: Does infection play a role in breast capsular contracture? Plast Reconstr Surg 68:34, 1981

    Google Scholar 

  35. Sperber WH: The identification of Staphylococci in clinical and food microbiology laboratories. CRC Crit Rev Clin Lab Sci 15:121, 1977

    Google Scholar 

  36. Thomalla JV, Thompson ST, Rowland RG, Mulcahy JJ: Infectious complications of penile prosthetic implants. J Urol 138:65, 1987

    Google Scholar 

  37. Thornton JW, Argenta LC, McClatchey KD, Marks MW: Studies of the endogenous flora of the human breast. Ann Plast Surg 20:39, 1988

    Google Scholar 

  38. Young EJ, Sugarman B: Infections in prosthetic devices. Surg Clin N Am 68:167, 1988

    Google Scholar 

Download references

Author information

Affiliations

  1. San Diego, California, USA

    Charles P. Virden M.D., Marek K. Dobke M.D., Paul Stein Ph.D., C. Lowell Parsons M.D. & David H. Frank M.D.

Authors
  1. Charles P. Virden M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marek K. Dobke M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul Stein Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Lowell Parsons M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David H. Frank M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

This study was supported by a grant from the American Society for Aesthetic Plastic Surgery, Inc.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Virden, C.P., Dobke, M.K., Stein, P. et al. Subclinical infection of the silicone breast implant surface as a possible cause of capsular contracture. Aesth. Plast. Surg. 16, 173–179 (1992). https://doi.org/10.1007/BF00450610

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00450610

Key words

  • Breast
  • Implant
  • Capsule
  • Contracture
  • Infection