Improving Biofilm Prevention in Implant-Based Breast Surgery: Hyaluronic Acid as an Implant Submersion Adjunct

Capsular contracture is a common major complication of implant-based breast surgery. Although its etiology is incompletely understood, biofilm formation on implant surfaces is considered a central factor. Plastic surgeons have adopted many risk-reducing measures; however, these measures are heterogeneous, and capsular contracture rates remain high. Recent studies have demonstrated the antibiofilm effects of hyaluronic acid on various surgical prostheses. Our study tests the in vitro antibiofilm properties of hyaluronic acid as a breast implant submersion adjunct.

Six-millimeter-diameter silicone disks were cut from smooth tissue expanders and treated with different concentrations of hyaluronic acid alone or combined with triple antibiotic solution (clindamycin, cefazolin, and gentamicin at 450, 1000, and 80 mg/mL, respectively). Following treatment, the disks were submerged in tryptic soy broth inoculated with Staphylococcus epidermidis strain RP62A and incubated for 60 hours to allow biofilm formation. Biofilms were stained with crystal violet, and the stain was extracted to measure optical density as a marker of biofilm formation.

Hyaluronic acid submersion exerted dose-dependent antibiofilm effects; hyaluronic acid 1.2% (wt/vol) solution produced a biofilm reduction similar to that achieved by the triple antibiotic solution. Synergistic effects were observed in the combination treatments, with hyaluronic acid 0.8% (wt/vol) in triple antibiotic solution producing the greatest biofilm reduction. This treatment produced a mean optical density of 0.313, which is significantly lower than that of the positive control (2.539; P < 0.001) and triple antibiotic solution alone (0.877; P < 0.001). These findings represent biofilm reductions of 87.7% and 64.3%, respectively.

Hyaluronic acid shows potential as an adjunct to triple antibiotic breast implant submersion. Pretreating silicone disks with hyaluronic acid 0.8% (wt/vol) in triple antibiotic solution led to biofilm reductions of 87.7% and 64.3% compared with the positive control and the triple antibiotic solution, respectively. These effects, combined with hyaluronic acid's biocompatibility, resorbability, and viscosity, demonstrate its promise for the prevention of capsular contracture in implant-based breast surgery.