Does Biofilm Play a Role in Breast Implant Illness?

Biofilms – or communities of bacteria that adhere to surfaces – contribute to about 80% of all human infections. The concept of biofilms forming on medical implants is an emerging topic that has implications for a range of surgical procedures, as infections are a primary reason that breast implants are removed.

Though breast implantation surgery is thought to be generally safe, potentially harmful biofilms have been detected on implantable materials and may lead to infections. Bacteria known as gram-positive bacteria are the most common culprits for these infections. As breast implants are one of the most popular types of implants, there is growing interest in clarifying the relationship between breast implants and the development and consequences of biofilms.

It has become clear that biofilms become problematic for implants through a process. First, they attach to the implant surface. They then mature and grow on that surface. Finally, they disperse into the environment, which enables them to continue to thrive and transmit disease.

Infection may cause long-term effects

When the body recognizes the presence of foreign microbial biofilms, the immune system responds, attempting to eliminate the potential threat. Persistent inflammation often results in the surrounding tissue. Unfortunately, antibiotics, which are frequently used to combat microbial infections, cannot access the biofilms on breast implants because the bacteria are trapped.

In addition to the short-term threats posed by infection, research also suggests that the infections that result from biofilms on breast implants may have long-term adverse health consequences. For example, the identification of bacterial biofilm in breast-implant-associated anaplastic large-cell lymphoma (ALCL) points to the possibility that infections caused by these biofilms could lead to this form of lymphoma.

Biofilms lead to further surgeries

Biofilms are also implicated in the most frequently discussed complication that occurs with breast implants – known as capsular contracture. When capsular contracture occurs, the collagen capsule that forms around the breast implant tightens. In addition to potentially causing pain, this tightening can also distort the shape of the breast.

The frequency and consequences of capsular contracture have made it the leading reason for breast surgery revision, where people undergo additional procedures to mitigate complications resulting from the initial one. The incidence of capsular contracture is unclear, with estimates ranging from 5% to 74% of breast reconstructive surgeries. It has been reported that surgeons diagnose roughly 45,000 capsular contractures each year.

Though the causes for contractures are multifactorial, bacterial biofilms are known to play an important role. It is thought that the inflammation that occurs in response to biofilms leads to thickening and scarring around the capsule – and eventually, contracture.

How to prevent biofilm formation

Because of the futility of antibiotics and the frequent need for surgical intervention when biofilms arise on breast implants, prevention is considered the best approach. Fortunately, research into how to address the potential for microbial biofilms on breast implants has shown that biofilms can be prevented.

There are several strategies that both manufacturers and surgeons can use to reduce the risk of biofilm formation on breast implants. For example, implants coated with the right type of antimicrobial agent have also been shown to reduce the risk of biofilm formation. Some experts also argue for the use of betadine, and nipple shields have been shown to reduce the incidence of capsular contracture.

Using certain implant materials can also help. In certain breast implant surgeries, textured implants are better than implants with smooth surfaces at preventing bacteria from adhering to the implants, which hinders the ability of biofilms to form. The greater surface area of textured implants compared to smooth implants is thought to contribute to the reduction in the risk of biofilm formation.

The potential threat of the presence of biofilms on breast implants – and other implantable devices – has become increasingly clear. Luckily, research is helping to explain the specific threats and how they arise so that the medical community can more effectively manage the threat through prevention.