Breast implants: Testing for contamination

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  • Published: Feb 1, 2012
  • Author: David Bradley
  • Channels: UV/Vis Spectroscopy
thumbnail image: Breast implants: Testing for contamination

Breast test

UV-Vis spectroscopy is one of the analytical tools used to test the safety of breast implant implantation based on a funnel, as opposed to digital method. Results show that overt infection and biofilm formation might be better avoided using the funnel technique to avoid contamination.

Over four million women worldwide have received prosthetic breast implants either for reconstructive purposes following mastectomy or for aesthetic reasons. Safety issues have been prominent in the news recently because of claims that one implant manufacturer used industrial-grade, rather than medical-grade materials, leading to undue worries for many of the women who received this companies products. The difference between industrial and medical grade materials is essentially one of labelling but of much more concern are the issues of contamination during insertion of prosthetic breast implants.

Hunter Moyer, Bahair Ghazi, Neil Saunders and Albert Losken of the Division of Plastic and Reconstructive Surgery, at Emory University, in Atlanta, Georgia, have investigated the problem of overt infection and biofilm formation resulting from breast augmentation. They point out that these are very rare but serious problems, that often cause prosthetic contracture and occasionally require revision surgery. They point out that digital insertion by the surgeon could be problematic and the team has looked at the alternative approach based on the Keller Funnel.

The Keller Funnel is a medical device composed of a rip-stop nylon sleeve with a hydrophilic inner coating, the team says. The manufacturer of this device emphasise that it is a "no touch" approach to prosthetic insertion that can reduce the risk of contamination. However, aside from manufacturer assertions there was until now no evidence that digital versus funnel was better or worse in terms of contamination.

Post mortem breast implants

To verify whether or the Keller funnel might be a better system than digital insertion, the Emory team have tested insertion techniques on two fresh cadavers. They implanted smooth, round, silicone gel implants into the cadavers using either the digital or funnel technique. In order to measure the degree of skin contamination, they painted a 2% fluorescein paste on to the chest of the cadaver. After implantation, the implants were soaked in sterilised water, and the fluorescence emission of the resulting solution was determined by UV-Vis spectroscopy; the fluoroscein paste essentially acting as a proxy for bacteria on the chest skin during the implant surgery.

The team also swabbed the cadaver breast tissue with non-resistant Staphylococcus aureus and then cultured the surfaces of the implants after implantation.

Fundamentally, the device-based implantation technique reduced skin contact by 27 times for all smooth gel implants. They also found that the bigger the implant the greater the risk of contamination regardless of the technique used to implant the prosthesis. The amount of skin contact and potential contamination increased incrementally with increasing implant volume when either the funnel or digital implantation techniques were used. The researchers add that bacterial contamination from breast parenchyma was twice as likely with conventional digital insertion than when the Keller funnel was used.

Funnel approach cuts contamination

Capsular contracture, often due to contamination (evidence suggests in three-quarters of all cases), leads to a need for revisional surgery in anywhere from 5 to 74% of implantations. "The Keller Funnel appears to significantly reduce the amount of skin contact and potential parenchyma contamination during implantation of smooth gel breast implants in a cadaver model. Technical refinements when employing the funnel can result in a 'minimal touch' technique that may lead to reduced infections and contracture," the team concludes.


The views represented in this article are solely those of the author and do not necessarily represent those of John Wiley and Sons, Ltd.

UV-Vis spectroscopy is one of the analytical tools used to test the safety of breast implant implantation based on a funnel, as opposed to digital method. Results show that overt infection and biofilm formation might be better avoided using the funnel technique to avoid contamination.

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