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Published on: April 9, 2013
Clinical relevance of positive breast periprosthetic cultures without overt infection
D T Netscher1, G Weizer, P Wigoda
1Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, USA.
Insights
Positive breast implant cultures are common even without infection, occurring in 23.5% of explants. These positive cultures, often from less virulent bacteria, were significantly associated with symptomatic capsular contracture (Baker class IV).
Area of Science:
- Plastic Surgery
- Microbiology
- Biomaterials Science
Background:
- The prevalence of positive breast periprosthetic cultures in asymptomatic patients is not well-defined.
- Many breast implants are removed for reasons other than overt infection, including musculoskeletal issues, capsular contracture, or rupture.
Purpose of the Study:
- To determine the incidence of positive breast periprosthetic cultures in implants removed for non-infectious reasons.
- To investigate the clinical relevance of positive cultures by correlating them with specific explant indications and outcomes.
Main Methods:
- Retrospective review of data from 389 breast implants removed for non-infectious etiologies.
- Analysis of periprosthetic capsule tissue cultures for microbial growth.
- Statistical evaluation of culture results against clinical data, including capsular contracture, implant rupture, and implant characteristics.
Main Results:
- A positive culture rate of 23.5% was identified from periprosthetic capsule tissue.
- Commonly cultured organisms included coagulase-negative staphylococci and anaerobic diphtheroids; more pathogenic fungi and bacteria were also detected.
- A statistically significant association was found between positive culture results and symptomatic capsular contracture (Baker class IV).
Conclusions:
- Positive breast periprosthetic cultures are frequent in explants removed for non-infectious reasons.
- Symptomatic capsular contracture (Baker class IV) is significantly correlated with the presence of microbial organisms in the periprosthetic capsule.
- These findings suggest a potential role for subclinical microbial colonization in the pathogenesis of capsular contracture.
Abstract:
The true incidence of positive breast periprosthetic cultures in the absence of overt infection is not clearly established. We retrospectively reviewed data from 389 implants that were removed for reasons other than clinical infection. Many of these patients presented with a variety of musculoskeletal ailments. Others had symptomatic capsular contracture as the presenting complaint. In a few a known implant rupture was the reason for explantation. We identified a positive culture rate of 23.5 percent from capsule tissue. Most of these organisms were coagulase-negative staphylococci and anaerobic diphtheroids, but fungi and other organisms (generally felt to be more pathogenic than the less virulent coagulase-negative staphylococci) also were cultured. In an attempt to identify the clinical relevance of these positive cultures, we statistically evaluated the culture results for associations with capsular contracture, implant rupture, type of implant, and location of implant. Of these, the only statistically significant correlation was between positive culture result and symptomatic capsular contracture (Baker class IV).
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