Recent statistics show as many as 60-thousand patients a year experience capsular contracture in the United States alone. It’s the most common complication of aesthetic and reconstructive breast implant surgery. The nearly 20 percent of patients who develop capsular contracture *(see note below) will see signs of breast firmness, shape distortion, and sometimes pain within the first two years of breast implant surgery.
Peter Rubin MD, a board certified plastic surgeon in Philadelphia says capsular contracture is a very difficult problem in plastic surgery. “It can affect a significant number of women who have breast implants and we’re constantly searching for reasons why this occurs and ways to treat this effectively,” says Rubin.
Biofilms – Reason Behind Capsular Contracture?
Australian plastic surgeon and worldwide biofilm expert, Dr. Anand Deva explains how bacteria can cause capsular contracture. “The bacteria get access to the implant at the time of surgery, they form a thin film over the implant which subsequently goes on to cause inflammation, which then causes scar tissue to build and you have capsular contracture,” says Anand.
Breast implants have had a long association with bacteria and more recently biofilms. Biofilms are a community of bacteria protected by an armor-like coating making them difficult to treat. They can also form on any foreign device placed in the body; orthopedic implants, pacemakers, dentures, or injectable fillers.
“One of the theories for breast implant capsular contracture is a low grade infection and that’s where biofilms come in,” saysDr. John Gross, a board certified plastic surgeon from Los Angeles. Gross says meticulous technique in the operating room is one way to diminish the occurrence of biofilms.
Reducing Capsular Contracture Starts in the OR
William P. Adams Jr. MD, a breast augmentation specialist in Dallas says “What we can do in the operating room is minimize any points of contamination; we use special antibiotic irrigations and atraumatic techniques. All of these strategies contribute to minimizing infection for patients.”
A popular way to combat bacteria and biofilms is using antibiotic irrigation combinations that clean the breast implant before it’s placed in the patient. The problem with this, says Dr. Adams, is that bacteria are becoming increasingly resistant. He says a recent strategy in the battle against biofilms studied a biodegradable antibiotic impregnated film that eradicates biofilms.
Dr. Deva recently worked on the project funded by the Aesthetic Surgery Education and Research Foundation (ASERF) to study these antibiotic films. “We looked at strategies to try and prevent bacteria actually getting access to the implant at the time of surgery. We used an antibiotic mesh and by placing this around the breast at the time of surgery, it significantly reduced the incidence of capsular contracture long term,” says Anand.
The surgeons we interviewed felt that these new anti-biofilm technologies will have a big impact for patients and medicine. They say current advances are already reducing capsular contracture rates and making breast implant procedures safer for patients.
* Note: Dr. Sterling has a documented capsular contracture rate of less than 5% in his practice.