The Functional Influence of
Breast Implant Outer Shell Morphology on Bacterial Attachment and Growth
by Jones, Phoebe;
Mempin, Maria; Hu, Honghua; Chowdhury, Durdana; Foley, Matthew; Cooter, Rodney;
Adams, William P. Jr; Vickery, Karen; Deva, Anand K.
Background: The
introduction of texture to the outer shell of breast implants was aimed at
increasing tissue incorporation and reducing capsular contracture. It has also
been shown that textured surfaces promote a higher growth of bacteria and are
linked to the development of breast implant–associated anaplastic large cell
lymphoma.
Methods: The
authors aimed to measure the surface area and surface roughness of 11 available
implants. In addition, the authors aimed to subject these implant shells to an
in vitro bacterial attachment assay with four bacterial pathogens
(Staphylococcus epidermidis, S. aureus, Pseudomonas aeruginosa, and Ralstonia
pickettii) and study the relationship among surface area, surface roughness,
and bacterial growth. Results: Surface area measurement showed grouping of
implants into high, intermediate, low, and minimal. Surface roughness showed a
correlation with surface area. The in vitro assay showed a significant linear
relationship between surface area and bacterial attachment/growth. The high
surface area/roughness implant texture grew significantly more bacteria at 24
hours, whereas the minimal surface area/roughness implant textures grew
significantly fewer bacteria of all types at 24 hours. For implants with
intermediate and low surface areas, some species differences were observed,
indicating possible affinity of specific bacterial species to surface
morphology.
Conclusions:
Implant shells should be reclassified using surface area/roughness into four
categories (high, intermediate, low, and minimal). This classification is
superior to the use of descriptive terms such as macrotexture, microtexture,
and nanotexture, which are not well correlated with objective measurement
and/or functional outcomes.
