Capsules, infection, and intraluminal antibiotics

Area of Science:

• Plastic Surgery
• Microbiology
• Biomaterials Science

Background:

• Staphylococcus epidermidis is a common skin bacterium found in nipple secretions and around breast implants.
• High percentages of fibrous capsules and surgical pockets show S. epidermidis presence.
• Capsular contracture is a common complication following breast augmentation surgery.

Purpose of the Study:

• To investigate the role of Staphylococcus epidermidis in breast implant capsular contracture.
• To evaluate the efficacy of intraluminal antibiotics in preventing capsular contracture.

Main Methods:

• Antibiotics (cephalothin and gentamicin) were placed within the lumen of breast implants.
• Antibiotic diffusion through the silicone shell was assessed in vitro.
• The incidence of capsular contracture was compared between patients receiving intraluminal antibiotics and those who did not.

Main Results:

• Cephalothin and gentamicin diffused through the silicone implant shell.
• Intraluminal antibiotic use significantly reduced capsular contracture rates after primary augmentation and secondary capsulotomy.
• This suggests a potential link between low-grade periprosthetic infection and contracture.

Conclusions:

• A low-grade periprosthetic infection may be the cause of fibrous capsular contracture.
• The silicone shell's permeability allows sustained antimicrobial activity, potentially preventing contracture.
• Intraluminal antibiotic delivery is a promising strategy to reduce breast implant complications.