EFFECT OF INFECTION ON CAPSULE FORMATION AFTER BREAST IMPLANTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TANGQi ¹ , ZHOUShaoqiang ¹ ,  HUANGYunchao ²

1. Second Department of Breast Surgery, the Third Affiliated Hospital of Kunming Medical University, the Tumor Hospital of Yunnan Province, Kunming Yunnan, 650118, P. R. China;
2. Department of Cardiovascular Surgery, the Third Affiliated Hospital of Kunming Medical University, the Tumor Hospital of Yunnan Province, Kunming Yunnan, 650118, P. R. China;

Corresponding?author：

HUANGYunchao, Email: huangych2001@aliyun.com

Keywords：

Breast implant; Infection; Capsule; Staphylococcus epidermidis; Pig

DOI：

10.7507/1002-1892.20150326

Video：

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Objective To investigate the correlation between infection and capsular contracture by observing the effect of infection on the formation of the surrounding capsule after breast implants. Methods Three healthy adult female Diannan small-ear pigs underwent augmentation mammaplasty using miniature implants, which were randomly divided into group A (12 nipples), group B (10 nipples), and group C (12 nipples). Staphylococcus epidermidis (SE ATCC12228 and SE RP62A, 1.2×10⁵ CFU/mL) was inoculated into the periprosthetics of groups B and C, and sterile PBS in group A before breast implants. Then the silica gel prosthesis was put, total 34 implants in 3 groups. After 13 weeks, the capsule was harvested to measure the capsular tension and weight. HE staining was used to observe the structure characteristics of the capsule and to measure the capsule thickness, Van-Gieson (VG) staining to observe the capsule collagen characteristics, and α-smooth muscle actin (α-SMA) immunocytochemistry staining to observe myofibroblasts in capsule. Results Primary healing of incision was obtained, and 3 small-ear pigs showed stable life indication. The complete fibrous capsule was observed after 13 weeks in 3 groups. Capsule tension showed no significant difference among 3 groups (P>0.05). Capsule weight was significantly greater in group C than in groups A and B (P<0.05). HE staining showed that capsule structure of the 3 groups was similar with obvious dense layer and loose layer, and the capsule thickness was also significantly greater in group C than in groups A and B (P<0.05), but no significant difference was found between groups A and B (P>0.05). VG staining showed that collagenous fiber in the capsule were more compact in group C than in groups A and B. The α-SMA immunocytochemistry staining indicated the myofibroblasts in capsule were the most in group C. Conclusion Infection after breast implants has obvious impacts on the formation of the capsule, and there was a causal link between infection and capsular contracture.

Citation： TANGQi, ZHOUShaoqiang, HUANGYunchao. EFFECT OF INFECTION ON CAPSULE FORMATION AFTER BREAST IMPLANTS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(12): 1523-1527. doi: 10.7507/1002-1892.20150326 Copy

1.	Marangi GF, Langella M, Gherardi G, et al. Microbiological evaluation of tissue expanders in patients who had first stage breast reconstruction. Plast Surg Hand Surg, 2010, 44(4-5):199-203.
2.	Rieger UM, Mesina J, Kalbermatten DF, et al. Bacterial biofilms and capsular contracture in patients with breast implants. Br J Surg, 2013, 100(6):768-774.
3.	Wixtrom RN, Stutman RL, Burke RM, et al. Risk of breast implant bacterial contamination from endogenous breast flora, prevention with nipple shields, and implications for biofilm formation. Aesthet Surg, 2012, 32(8):956-963.
4.	Araco A, Caruso R, Araco F, et al. Capsular contractures:a systematic review. Plast Reconstr Surg, 2009, 124(6):1808-1819.
5.	Bartsich S, Ascherman JA, Whittier S, et al. The breast:a cleancontaminated surgical site. Aesthet Surg, 2011, 31(7):802-806.
6.	Rieger UM, Mesina J, Kalbermatten DF, et al. Bacterial biofilms and capsular contracture in patients with breast implants. Br Surg, 2013, 100(6):768-774.
7.	Waines PL, Moate R, Moody AJ, et al. The effect of material choice on biofilm formation in a model warm water distribution system. Biofouling, 2011, 27(10):1161-1174.
8.	葉聯華, 黃云超, 李高峰, 等. 生物材料植入后發生感染與表皮葡萄球菌生物膜. 生物醫學工程與臨床, 2010, 14(1):79-82.
9.	Kadry AA, Fouda SI, Shibl AM, et al. Impact of slime dispersants and anti-adhesives on in vitro biofilm formation of Staphylococcus epidermidis on intraocular lenses and on antibiotic activities. J Antimicrob Chemother, 2009, 63(3):480-484.
10.	Gill SR, Fouts DE, Archer GL, et al. Insights on evolution of virulence and resistance from the complete genome analysis of an early methicillin-resistant Staphylococcus aureus strain and a biofilm-producing methicillin-resistant Staphylococcus epidermidis strain. Bacteriol, 2005, 187(7):2426-2438.
11.	Tamboto H, Vickery K, Deva AK. Subclinical (biofilm) infection causes capsular contracture in a porcine model following augmentation mammaplasty. Plast Reconstr Surg, 2010, 126(3):835-842.
12.	Golus J, Stankevic M, Sawicki R, et al. Quantitative analysis of biofilm formed on vascular prostheses by Staphylococcus epidermidis with different ica and aap genetic status. Int J Artif Organs, 2013, 36(2):105-112.
13.	馬勇光, 石蕾, 陳東明, 等. 乳房假體周圍纖維包囊的組織學研究. 中華整形外科雜志, 2002, 18(3):143-145.
14.	Desmoulière A, Darby IA, Gabbiani G. Normal and pathologic soft tissue remodeling:Role of the myofibroblast, with special emphasis on liver and kidney fibrosis. Lab Invest, 2003, 83(12):1689-1707.
15.	Hinz B, Gabbiani G. Mechanisms of force generation andtransmission by myofibroblasts. Curr Opin Biotechnol, 2003, 14(5):538-546.
16.	王春玲, 邢新. 肌成纖維細胞與瘢痕. 中國組織工程研究與臨床康復, 2007, 11(6):1117-1119.
17.	Moyer KE, Ehrlich HP. Capsular contracture after breast reconstruction:collagen fiber orientation and organization. Plast Reconstr Surg, 2013, 131(4):680-685.
18.	湯琦, 劉馨, 黃云超, 等. 表皮葡萄球菌對成纖維細胞的增殖及表型轉變的影響研究. 中華醫院感染學雜志, 2014, 24(4):781-784.

1. Marangi GF, Langella M, Gherardi G, et al. Microbiological evaluation of tissue expanders in patients who had first stage breast reconstruction. Plast Surg Hand Surg, 2010, 44(4-5):199-203.
2. Rieger UM, Mesina J, Kalbermatten DF, et al. Bacterial biofilms and capsular contracture in patients with breast implants. Br J Surg, 2013, 100(6):768-774.
3. Wixtrom RN, Stutman RL, Burke RM, et al. Risk of breast implant bacterial contamination from endogenous breast flora, prevention with nipple shields, and implications for biofilm formation. Aesthet Surg, 2012, 32(8):956-963.
4. Araco A, Caruso R, Araco F, et al. Capsular contractures:a systematic review. Plast Reconstr Surg, 2009, 124(6):1808-1819.
5. Bartsich S, Ascherman JA, Whittier S, et al. The breast:a cleancontaminated surgical site. Aesthet Surg, 2011, 31(7):802-806.
6. Rieger UM, Mesina J, Kalbermatten DF, et al. Bacterial biofilms and capsular contracture in patients with breast implants. Br Surg, 2013, 100(6):768-774.
7. Waines PL, Moate R, Moody AJ, et al. The effect of material choice on biofilm formation in a model warm water distribution system. Biofouling, 2011, 27(10):1161-1174.
8. 葉聯華, 黃云超, 李高峰, 等. 生物材料植入后發生感染與表皮葡萄球菌生物膜. 生物醫學工程與臨床, 2010, 14(1):79-82.
9. Kadry AA, Fouda SI, Shibl AM, et al. Impact of slime dispersants and anti-adhesives on in vitro biofilm formation of Staphylococcus epidermidis on intraocular lenses and on antibiotic activities. J Antimicrob Chemother, 2009, 63(3):480-484.
10. Gill SR, Fouts DE, Archer GL, et al. Insights on evolution of virulence and resistance from the complete genome analysis of an early methicillin-resistant Staphylococcus aureus strain and a biofilm-producing methicillin-resistant Staphylococcus epidermidis strain. Bacteriol, 2005, 187(7):2426-2438.
11. Tamboto H, Vickery K, Deva AK. Subclinical (biofilm) infection causes capsular contracture in a porcine model following augmentation mammaplasty. Plast Reconstr Surg, 2010, 126(3):835-842.
12. Golus J, Stankevic M, Sawicki R, et al. Quantitative analysis of biofilm formed on vascular prostheses by Staphylococcus epidermidis with different ica and aap genetic status. Int J Artif Organs, 2013, 36(2):105-112.
13. 馬勇光, 石蕾, 陳東明, 等. 乳房假體周圍纖維包囊的組織學研究. 中華整形外科雜志, 2002, 18(3):143-145.
14. Desmoulière A, Darby IA, Gabbiani G. Normal and pathologic soft tissue remodeling:Role of the myofibroblast, with special emphasis on liver and kidney fibrosis. Lab Invest, 2003, 83(12):1689-1707.
15. Hinz B, Gabbiani G. Mechanisms of force generation andtransmission by myofibroblasts. Curr Opin Biotechnol, 2003, 14(5):538-546.
16. 王春玲, 邢新. 肌成纖維細胞與瘢痕. 中國組織工程研究與臨床康復, 2007, 11(6):1117-1119.
17. Moyer KE, Ehrlich HP. Capsular contracture after breast reconstruction:collagen fiber orientation and organization. Plast Reconstr Surg, 2013, 131(4):680-685.
18. 湯琦, 劉馨, 黃云超, 等. 表皮葡萄球菌對成纖維細胞的增殖及表型轉變的影響研究. 中華醫院感染學雜志, 2014, 24(4):781-784.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECT OF INFECTION ON CAPSULE FORMATION AFTER BREAST IMPLANTS

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