BREAST PROSTHESIS, INFECTION AND BIOFILMS

Infection that occurs around a breast prosthesis or any implantable medical device is a challenging and difficult problem.  Rates of infection are higher in breast reconstruction using a prosthetic implant (1-35.4%) compared to augmentation mammoplasty (0.4-2.5%).  Although salvage of an infected prosthesis is always the goal, it is seldom successful. The typical methods used to try to save an infected prosthesis include oral &/or systemtic (I.V.) antibiotics based on culture and sensitivity results, irrigation and drainage procedures, antibiotic pulsed lavage, removal of the capsule surrounding the implant, exchanging the implant, and possible post-operative continuous antibiotic irrigation.
There is a higher percentage of infection associated with smoking, chemotherapy and radiation therapy. There is less likely to be a successful salvage of the prosthesis if the wound culture organisms are methicillin-resistant Staphylococcus Aureus (M.R.S.A.), gram negative rods such as Pseudomonas Aeruginosa, mycobacteria or yeast. I have also found that patients with significant erythema in the mastectomy skin, thin tissues and implant exposure are in a poor prognostic group for salvage.
Why is it so difficult to treat infection around a prosthetic medical device?  One theory is that certain bacteria form a Biofilm.  A Biofilm is a mucopolysaccharide "slime layer" that adheres to a breast implant and forms a "protective barrier" for the bacteria which isolates them from antibiotics and from the infection-fightening capabilities of the immune system.  The molecular mechanisms of biofilm formation are beyond my understanding and involve a complicated process that is being looked at carefully in the research labs. Of interest, it has been also shown that biofilms may play a role in certain burn infections that show multi-drug resistance and in certain non-healing wounds.
An infection around a breast prosthesis is a major problem!  This results in prolonged treatment and recovery, additional surgeries, more expense, central lines for weeks of I.V. antibiotics (with the risk of line sepsis), additional hospitalization and psychological issues for both the patient and doctor. As with many things in life, prevention is the key.  Before, during and after surgery we take extra precautions above and beyond our normal sterile technique to try to reduce the chances of infection around a breast prosthesis.