American Association of Plastic Surgeons

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In-vitro Testing of Bacterial Attachment and Biofilm Formation on Different Breast Implant Outer Shell Surfaces
Garth James, PhD1, Laura Boegli, BS.1, John Hancock, BSME2, Brian M. Kinney, MD3.
1Montana State University, Bozeman, MT, USA, 2Establishment Labs, Santa Barbara, CA, USA, 3University of Southern California, Beverly Hills, CA, USA.

PURPOSE:
Bacterial biofilms have been implicated with breast implant complications including capsular contracture and anaplastic large-cell lymphoma. Due to their increased surface area, implants with textured surfaces may harbor greater biofilm loads than those with smooth surfaces.
METHODS:
Biofilm formation on the outer surface material was compared using implants with various surface areas and roughness, including smooth controls, SmoothSilk®/SilkSurface®, VelvetSurface®, Siltex®, and Biocell®. Bacterial attachment (2 hours) and biofilm formation (24 hours) were evaluated for Staphylococcus epidermidis and Pseudomonas aeruginosa using a CDC biofilm reactor and viable plate counts (VPC) as well as confocal scanning laser microscopy (CSLM). For VPC, the amount of biofilm on the textures was compared relative to smooth using ANOVA and a 95% confidence level.
RESULTS:
For S. epidermidis , fewer bacteria were attached (2h) to SmoothSilk®/SilkSurface® , than Siltex®. Differences were more apparent for S. epidermidis biofilm formation (24h), where there was less biofilm on SmoothSilk®/SilkSurface® and VelvetSurface® than Siltex® and Biocell®. In contrast, there were no differences between textures for P. aeruginosa biofilm formation, but significant differences in attachment (2h). There was less attachment (2h) on SmoothSilk®/SilkSurface® than any other texture including the smooth control; there was less attachment on VelvetSurface® than Siltex® and Biocell®. CSLM also indicated that the surfaces with greater area and roughness had more bacterial attachment and biofilm formation.
CONCLUSION:
Overall, these results indicate that surface textures may play an important role in bacterial attachment and biofilm formation on breast implant surfaces, that may differ between different bacterial species.


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