Association Between Breast Microbiota and Capsular Contracture: A Systematic Review

Capsular contracture (CC), a common complication of breast implants, has an unclear etiology. Subclinical infection around the implant is widely considered a potential cause. Microorganisms, such as Staphylococcus epidermidis, have been associated with CC, but the specific role of bacteria from the breast capsule, glandular tissue, or skin remains unclear. No molecular studies have definitively investigated this association. The authors of this systematic review aim to evaluate the relationship between breast microbiota, bacterial biofilms, and CC in patients undergoing cosmetic or reconstructive breast augmentation. Data were extracted from studies identified through different search engines, including Medline and Embase. Inclusion criteria focused on patient, surgical, and implant-related factors influencing CC. Only English-language articles were considered. The review included 428 women (453 breast implants) aged 27 to 53 years, with an average age of 31. Most studies lacked detailed reporting on implant characteristics or surgical techniques. The majority employed cell culture or pathology for microbiota assessment, with 1 study using polymerase chain reaction (PCR). Frequently identified bacteria included S. epidermidis, Propionibacterium acnes, and Streptococcus spp. This systematic review of 428 women with 453 breast implants found that S. epidermidis, P. acnes, and Streptococcus spp. were the most frequently isolated microorganisms in CC cases. The majority of studies used cell culture or pathology for microbiota assessment, with 1 employing PCR. Bacterial biofilm, particularly involving S. epidermidis, was consistently reported in contracted capsules, suggesting a strong association between specific breast microbiota and CC. Level of Evidence: 2 (Risk).