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Characterization of microbial presence at the surface of silicone mammary implants
M K Dobke1, J K Svahn, V L Vastine
1Division of Plastic Surgery, University of California Medical Center, San Diego, USA.
Abstract:
The purpose of this project was to examine the incidence of microbial presence on the surface of mammary implants and its correlation with clinical presentation. The significance of microbial presence without signs of overt infection is questioned. Several issues are raised, including whether the presence of micro-organisms may immunize the host, trigger autoimmune reactions, or locally change the course of healing (resulting in capsular contracture). A total of 150 explanted silicone mammary implants from 87 patients were cultured. Cultures of 81 devices were positive (54%); the predominant isolate was Staphylococcus epidermidis (found on 68 implants, or 84%). Bacteria were detected on 76% (62 of 82) of implants surrounded by contracted capsules and on 28% (19 of 68) of those without capsular contracture (p < 0.05). Among 40 patients (46%) who had no general health problems, 11 (28%) had positive cultures of explanted devices (15 of 62 explants, or 24%). In the remaining 47 patients (54%) who complained of myalgia (77%), arthralgia (68%), chronic fatigue (38%), skin rashes (21%), cognitive problems (19%), dry mucosal membranes (19%), episodes of low-grade fever (17%), and hair loss (13%), 38 (81%) had positive cultures (66 of 88 explants, or 75%) (p < 0.05). The hypothesis that capsular contracture or problems that might be related to chronic infection and immunization are associated with subclinical infection is supported by this study.
Insights
Subclinical infections on mammary implants are common, with bacteria found on 54% of explants. This microbial presence correlates with capsular contracture and systemic symptoms, suggesting a link to chronic conditions.
Area of Science:
- Plastic Surgery
- Microbiology
- Immunology
Background:
- Microbial presence on mammary implants without overt infection is poorly understood.
- Potential implications include host immunization, autoimmune reactions, and altered healing (capsular contracture).
Purpose of the Study:
- To investigate the incidence of microbes on explanted mammary implants.
- To correlate microbial presence with clinical presentation, including capsular contracture and systemic symptoms.
Main Methods:
- Culturing of 150 explanted silicone mammary implants from 87 patients.
- Analysis of bacterial presence in relation to capsular contracture and patient-reported symptoms.
Main Results:
- Bacterial cultures were positive for 54% of implants (81/150).
- Staphylococcus epidermidis was the predominant isolate (84%).
- Higher bacterial detection rates were observed on implants with capsular contracture (76%) versus those without (28%).
- Patients reporting systemic symptoms (myalgia, fatigue, etc.) had significantly higher positive culture rates (75%) compared to asymptomatic patients (24%).
Conclusions:
- Subclinical microbial colonization of mammary implants is prevalent.
- Findings support the hypothesis that subclinical infections are associated with capsular contracture and systemic symptoms, potentially related to chronic infection and immunization.
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