ICOPLAST Award of Excellence: Tamir Shay

Israel / Israeli Society of Plastic and Aesthetic Surgery

Title: Nitric Oxide Charged Silicone Breast Implants as a Potential Strategy for Prevention of Biofilm Formation and capsular contracture

Background: Capsular contracture is a common complication after esthetic and reconstructive breast prosthesis implantation caused primarily by the formation of bacterial biofilm onto the implant surface. Using a novel technique developed by ENOX an anti-infective barrier on polymer-based medical devices is generated by charging the devices with Nitric Oxide (NO), a naturally-produced gas molecule with anti-biofilm capabilities that is slowly released for a period of 5-14 days upon contact with physiological fluids.

Aims: Asses whether NO-charged silicone breast implants inserted into swines for a period of 26 days prevent/reduce bacterial attachment and biofilm formation onto their surfaces.

Methods: 100cc control (CT-Gr, n=7) and NO-charged (NO-Gr, n=5) silicone breast implants were aseptically inserted into both sides of the trunk of 3 large white swines for a period of 26 days. After removal, the outer membrane of each implant was processed to small uni-size pieces (0.5cm2) and microbiological evaluation for bacterial attachment and biofilm formation onto their surfaces was performed using standard plating methods and Electron Microscopy (SEM). SWAB samples from the implantation site were taken to evaluate bacterial presence.

Results: Implants from the NO-Gr displayed less bacterial attachment onto their surfaces (40% of implants) compared to the CT-Gr (71.4% of implants). In addition, low amount of bacteria (3-25 CFU/site) were detected in 75% of SWAB samples from the CT-Gr, while negligible amount of bacteria (1 CFU/site) were detected in 33% of SWAB Samples from the NO-Gr. Biofilm-forming bacteria were not detected on the surface of samples from the CT-Gr and NO-Gr.

Conclusions: NO-charging of silicone breast implants might have a beneficial effect in reducing implant contamination during breast implantation surgery thus reducing biofilm formation and capsular contracture downstream to the implantation procedure.