Macrotextured breast implants with defined steps to minimize bacterial contamination around the device: Experience in 42,000 implants

William P. Adams, Eric J. Culbertson, Anand K. Deva, Mark R Magnusson, Craig Layt, Mark L. Jewell, Patrick Mallucci, Per Hedén

Research output: Contribution to journalArticlepeer-review

145 Scopus citations

Abstract

Background: Bacteria/biofilm on breast implant surfaces has been implicated in capsular contracture and breast implant-associated anaplastic large-cell lymphoma (ALCL). Macrotextured breast implants have been shown to harbor more bacteria than smooth or microtextured implants. Recent reports also suggest that macrotextured implants are associated with a significantly higher incidence of breast implant-associated ALCL. Using techniques to reduce the number of bacteria around implants, specifically, the 14-point plan, has successfully minimized the occurrence of capsular contracture. The authors hypothesize that a similar effect may be seen in reducing the risk of breast implant-associated ALCL. Methods: Pooled data from eight plastic surgeons assessed the use of macrotextured breast implants (Biocell and polyurethane) and known cases of breast implant-associated ALCL. Surgeon adherence to the 14-point plan was also analyzed. Results: A total of 42,035 Biocell implants were placed in 21,650 patients; mean follow-up was 11.7 years (range, 1 to 14 years). A total of 704 polyurethane implants were used, with a mean follow-up of 8.0 years (range, 1 to 20 years). The overall capsular contracture rate was 2.2 percent. There were no cases of implant-associated ALCL. All surgeons routinely performed all 13 perioperative components of the 14-point plan; two surgeons do not routinely prescribe prophylaxis for subsequent unrelated procedures. Conclusions: Mounting evidence implicates the role of a sustained T-cell response to implant bacteria/biofilm in the development of breast implant-associated ALCL. Using the principles of the 14-point plan to minimize bacterial load at the time of surgery, the development and subsequent sequelae of capsular contracture and breast implant-associated ALCL may be reduced, especially with higher-risk macrotextured implants.

Original languageEnglish (US)
Pages (from-to)427-431
Number of pages5
JournalPlastic and reconstructive surgery
Volume140
Issue number3
DOIs
StatePublished - Sep 2017

ASJC Scopus subject areas

  • Surgery

Fingerprint

Dive into the research topics of 'Macrotextured breast implants with defined steps to minimize bacterial contamination around the device: Experience in 42,000 implants'. Together they form a unique fingerprint.

Cite this