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Chronic subclinical bacterial colonization of periprosthetic capsulectomy specimens after implant removal

Katherine H. Carruthers, MD, MS, Ergun Kocak MD, MS, Pankaj Tiwari MD
West Virginia University
2020-11-23

Presenter: Katherine Carruthers, MD

Affidavit:
This work represents the original work of the resident

Director Name: Kerri Woodberry, MD

Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)

Background
Previous studies in the orthopedic literature have shown that slow growing infections surrounding implants can result in musculoskeletal complaints without overt clinical signs of infection. Propionibacterium acnes in particular, has been linked to delayed subclinical infections in the shoulder arthroplasty population. The goal of this study was to determine the incidence of bacterial colonization on explanted breast implants and capsules.

Methods
A retrospective analysis was performed on patients who presented for breast implant removal and capsulectomy over a 12 month period. In all cases, capsule tissue was sent for gross pathologic identification, as well as microbiologic examination for aerobic, anerobic, fungal, and acid-fast bacteria. The resulting data was analyzed to determine the percent of implants which had bacterial growth.

Results
A total of 200 patients underwent bilateral implant removal with total periprosthetic capsulectomy. Of these 400 implants, 27.50% (n=110) were found to have bacterial growth from the cultured capsule tissues, despite the fact that none of the patients were preoperatively exhibiting clinical signs of infection. 80.91% (n=89) of the implants with positive cultures were found to be growing Propionibacterium acnes.

Conclusion
The presence of bacteria on breast implants and capsules occurs at a high frequency, with Propionibacterium acnes being the dominate species identified. Given the correlation between Propionibacterium acnes and nonspecific musculoskeletal complaints from the orthopedic literature, future studies are needed to further understand if there is also a potential link between the presence of Propionibacterium acnes on breast implants and the non-specific symptoms some breast implant patients manifest.

Author Contact Information:
Katherine Carruthers
1 Medical Center Dr.
Morgantown, WV
26505

6142714068
6142714068 (cell)

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