Bacterial Biofilm on Tissue Expander and Acellular Dermal Graft After Breast Reconstruction

A 27-year-old female underwent bilateral mastectomy with left axillary dissection and had immediate breast reconstruction with textured silicone implants and acellular dermal graft (ADG) reinforcement of the inferior quadrants. The patient was maintained on oral antibiotics postoperatively and initially did well. However, she subsequently presented with fever, erythema, and tenderness in the left chest and was admitted for intravenous antibiotic therapy. Despite improvement of her symptoms, she ultimately cultured positive for Staphylococcus aureus and had the tissue expander and the ADG material explanted. These explanted specimens were immediately examined with confocal microscopy using Live/Dead staining under hydrated conditions for the presence of bacterial biofilms. Biofilm bacteria were clearly visualized adherent to both the tissue expander shell and also to the ADG surface. This is the first direct demonstration of viable bacteria in biofilm configuration on the surface of a tissue expander and acellular dermal graft after breast reconstruction.