Background
Silicone breast implants have been associated with conditions such as capsular contracture, autoimmune disease, anaplastic large cell lymphoma and breast implant illness. The presence of periprosthetic subclinical infection is one of the leading theories behind their pathophysiologies but its presence has not been consistently demonstrated in the medical literature.
Methods
From June 2018 all breast implant explantations and capsulectomies performed by our surgeons routinely had intracapsular swabs and capsular tissue sent for microbiological analysis and processed using a prolonged culture technique.
A retrospective analysis was performed of all elective silicone breast implant explantations and capsulectomies performed between June 2018 and August 2022 performed by two plastic surgeons in our institutions. Data collected included patient demographics, indication for original implants, capsular histology and microbiology from intracapsular swabs and capsular tissue.
Results
52 silicone implants and their capsules were removed in 27 women (25 Bilateral, 2 unilateral), mean age 54 (28-76).
Indications for original placement of implants were cosmetic augmentation (69%), post mastectomy reconstruction (15%) and gender reassignment (4%) and 12% were unknown.
48 of 52 capsulectomies had intracapsular swabs taken. 31% (15/48) of swabs were positive for bacteria. 96% (50/52) of capsules cultured were positive for bacterial growth. The most common microbes grown were Cutibacterium acnes (62%) and Staph epidermidis (62%).
There was one case of Breast Implant Associated Anaplastic Large Cell Lymphoma.
Discussion
Regardless of primary indication, almost all silicone breast implants capsules appear to harbour some degree of subclinical infection.
Our results indicate that subclinical infection around breast implants may be more common than previously thought.
Conclusions
This study adds weight to the theory that subclinical infection around breast implants may be the common stem to several pathologies associated with breast implants. Routine prolonged culture of capsular specimens should be universally adopted and used in future studies.