Does infection play a role in breast capsular contracture?

Area of Science:

• Plastic Surgery
• Biomaterials Science
• Microbiology

Background:

• Capsular contracture is the most frequent complication following augmentation mammaplasty.
• Etiologic factors for capsular contracture remain inconclusive.
• Subclinical infections are a potential, yet unconfirmed, cause.

Purpose of the Study:

• To investigate the role of subclinical Staphylococcus epidermidis infection in the development of capsular contracture around silicone implants.
• To evaluate the relationship between bacterial concentration and the severity of capsular contracture.

Main Methods:

• Miniature silicone implants were used in 16 rabbits.
• Implants were contaminated with varying concentrations of S. epidermidis.
• Capsular contracture severity was assessed using Baker's classification and histological analysis.

Main Results:

• All contaminated implants developed capsular contractures (Baker's grade III or IV), compared to controls (grade I or II).
• Contaminated capsules were significantly thicker (2-3 times) and firmer than controls.
• High bacterial concentrations (10^7) led to uniform implant extrusion.

Conclusions:

• Subclinical Staphylococcus epidermidis infection is a likely cause of capsular contracture around breast implants.
• Bacterial contamination directly correlates with the severity and physical characteristics of capsular contracture.