Capsular biofilm formation at the interface of textured expanders and human acellular dermal matrix: A comparative scanning electron microscopy study

Background: Despite benefits in reducing capsular contractures, textured implants have been associated with significant pitfalls such a propensity for biofilm formation. Few studies have investigated whether the use of acellular dermal matrix (ADM) on textured implants produces similar findings. This study aims to characterize biofilm formation at the capsular-ADM interface with scanning electron microscopy (SEM). Methods: We performed a prospective observational pilot study in patients undergoing two-stage expander-to-permanent implant exchange. Patients were inflated with Biocell® or Siltex® expanders and specimens from the capsular-pectoralis interface and capsular-ADM interface were obtained and examined under SEM for capsular ingrowth and biofilm formation using the Van Herdeen Grading System and Biofilm Thickness Grading Scale. Results: 9 patients including 14 breasts (28 capsular samples in total) were examined. Thick biofilm formation was observed in all specimen from the capsule-ADM interface with Biocell® and 25% of capsule-pectoralis interface, whereas no biofilm formation was found in Siltex® implants. For Biocell® implants, a significant difference in biofilm coverage between the upper and lower poles was observed using the Van Herdeen Grading System (p=0.0028) and the Biofilm Thickness Grading Scale (p=0.0161). Conclusions: Biocell® implants produce a significant rate of biofilm formation over ADM-covered capsules, which is not present in the muscular region or in Siltex® implants. Further randomized controlled trials will further elucidate the clinical impact of using ADMs with macro-textured implants. Financial Disclosure Statement: Dr. M. Alain Danino is a consultant and speaker for Allergan Inc. None of the other authors have any commercial associations or financial interests to declare with respect to any of the information or products presented in this submitted manuscript. Operational study costs were partially supported by an Allergan Inc. industry research grant. Meetings presented: ASPS 2016 Acknowledgments None Declaration of conflicts of interests: Dr. M. Alain Danino is a consultant and speaker for Allergan Inc. None of the other authors have any commercial associations or financial interests to declare with respect to any of the information or products presented in this submitted manuscript. Operational study costs were partially supported by an Allergan Inc. industry research grant. Corresponding author: Alain Michel Danino, MD PhD, Notre-Dame Hospital, University of Montreal Hospital Center, 1560 rue Sherbrooke Est, Montreal, Quebec, H2L 4M1, CANADA., daninoalain@gmail.com, Telephone: +1.514.8908000 ext 23757 , Fax: +1.514.4651773, Montreal, Quebec, Canada ©2017American Society of Plastic Surgeons