Biofilm & Infections

Scientific Articles: 

The relationship of bacterial biofilms and capsular contracture in breast implants (2016). Link.

Biofilm—“a structured community of bacterial cells enclosed in a self-produced polymeric matrix and adherent to an inert or living surface”

Biofilms are microbial communities that are attached to a surface, including living tissue, implants, and medical devices. Infections related to microbial biofilms represent a significant number of all microbial infections in humans.

These infections are difficult to treat, and as a result they become persistent and chronic. There is substantial evidence showing a correlation between the presence of microbial biofilms on various medical implants and persistent inflammation of the surrounding tissue.

It appears that microbial biofilms form on breast implants as well and might contribute to a chronic inflammatory response and thus formation of capsular fibrosis and subsequent contracture.

…correlation between biofilms on silicone shells and risk of CC.

Microbial evaluation: 139 implants removed from symptomatic patients (1996). Link.

• Forty-seven percent of 139 implants were culture-positive. Propionibacterium acnes was isolated most frequently (57.5 percent), followed by Staphylococcus epidermidis (41 percent), and then Escherichia coli (1.5 percent).

In vitro and in vivo investigation of the influence of implant surface on the formation of bacterial biofilm in mammary implants (2014). Link.

Propionibacterium acnes: from commensal to opportunistic biofilm-associated implant pathogen (2014). Link.

• Although often defined as a commensal, P. acnes is infrequently associated with invasive infections of the skin, soft tissue, cardiovascular system, or deep-organ tissues and is an important opportunistic pathogen causing implant-associated infections.
• This bacterial species is part of the normal microbiota of the skin, oral cavity, and gastrointestinal and genitourinary tracts and is usually not pathogenic. P. acnes grows better at a pH range of 6.0 to 7.0 than in a more acidic or alkaline milieu
• Pathogenesis: P. acnes produces a number of putative virulence factors and also causes disease by bacterial seeding, modification and manipulation of the host immune response, and biofilm formation.
• Number of putative virulence factors involved in host tissue-degrading activities, cell adhesion, inflammation, and slime/capsular polysaccharide biosynthesis. These factors included host tissue-degrading enzymes such as lipases/esterases, hyaluronate lyase (degrades hyaluronan, a constituent of the ex- tracellular matrix of connective tissue), endoglycoceramidases, four sialidases, and various extracellular peptidases. These enzymes may contribute to nutrient acquisition and immunoavoidance and may aid in bacterial seeding.
• Biofilm formation is one of the major virulence properties of P. acnes implant-associated infections and is apparently independent of the phylotype of P. acnes. P. acnes can act as an opportunistic pathogen causing invasive and chronic implant infections through a biofilm mode of growth.

The microbial epidemiology of breast implant infections in a regional referral centre for plastic and reconstructive surgery in the south of France (2015). Link.

Pilot study of association of bacteria on breast implants with capsular contracture (2009). Link.

• The results of this study demonstrate that there is a significant association between capsular contracture and the presence of bacteria on the implant.
•  Propionibacterium species, coagulase-negative staphylococci, and Corynebacterium species were the microorganisms isolated.

Candida colonisation within a silicone tissue expander (2002). Link.

•  The colonisation of silicone implants by opportunistic fungi is probably more common than has been reported, and precautions that can be taken to avoid this complication are emphasised.
• There are, however, occasional reports of fungi in association with inflatable mammary implants. We describe the colonisation of a tissue expander with Candida albicans, resulting in the fluid becoming a turbid brown colour.

Implant infection after augmentation mammaplasty: a review of the literature and report of a multidrug-resistant Candida albicans infection (2012). Link.

Bacterial biofilm infection detected in breast implant–associated anaplastic large-cell lymphoma (2016). Link.

The microbial epidemiology of breast implant infections in a regional referral centre for plastic and reconstructive surgery in the south of France (2015). Link.

• 17 species of bacteria were identified

Breast Implant Illness: A Way Forward (2019). Link.

• Suggests a need to investigate further the bacteria and microbiome of implants and capsules through “detection and characterization.”

Breast Implant Illness: A Biofilm Hypothesis (2020). Link.

• Chronic infection was found in 36% of cases with Propionibacterium acnes the most common finding.

Infection in breast implants (2005). Link.

An outbreak of Mycobacterium jacuzzii infection following insertion of breast implants (2006). Link.

A prosthetic breast implant infected with Mycobacterium fortuitum (2000). Link.

Mycobacterium Cheloneae infection after breast augmentation (2005). Link.

Staphylococcus aureus and Staphylococcus epidermidis virulence strains as causative agents of persistent infections in breast implants (2016). Link.

• They are currently considered two of the most important pathogens in nosocomial infections associated with catheters and other medical implants and are also the main contaminants of medical instruments
• However because these species of Staphylococcus are part of the normal bacterial flora of human skin and mucosal surfaces, it is difficult to discern when a microbial isolate may be the cause of infection or is the result of sample contamination.
• It has been observed that this ability to persist on medical devices is due to biofilms…which establish non-covalent interactions with host tissue or host proteins and are thus used to coat device surfaces. The biofilm forms a heterogeneous matrix, which is able to protect bacteria from antibiotic treatment, physiologic shear, and potentially from host immune defenses.
• Biofilm formation has been recognized during recent years as an extremely important factor contributing to the virulence of pathogenic bacteria in chronic infections. To study these phenotypes, we were able to observe how isolates from breast prostheses act as strong biofilm producers compared with moderate and strong producers in control samples.
• Clinical presentations in patients do not always provide a clear framework for diagnoses, but the presence of fever and leukocytosis associated with edema and swelling should suggest the possibility of an infection. It has been demonstrated that under physiological in vitro conditions, leukocytes attach to, penetrate, and produce cytokines in response to mature S. aureus biofilms. Similar results have been observed with other bacteria, indicating that biofilm formation associated with persistent infections may also cause chronic inflammation.

The story of Serratia Marcescens: pathologic risk factors in breast implant surgery (2014). Link.

Seroma in Prosthetic Breast Reconstruction (2016). Link.

• Seromas following prosthetic breast reconstruction are complicated by the hypovascular, proinflammatory milieu of the mastectomy skin flap, the geometrically complex dead space, and the presence of a foreign body with potential contamination and biofilm. There is reasonable evidence to suggest that these factors contribute to a progression of seroma to infection and prosthesis loss.

Detection of subclinical infection in significant breast implant capsules (2003). Link.

• This implicates biofilm disease in the pathogenesis of contracture. Scanning electron microscopy confirmed the presence of extensive biofilm on implants and within capsules. Biofilm, in particular, S. epidermidis biofilm, was detected for a significant proportion of patients with capsular contracture.