Will lip filler put me at higher risk of breast implant biofilm?

Hello, and thanks for the question. A biofilm is considered a "subclinical" infection in the sense that the bacteria are stopped from spreading by your immune system, but they are never completely wiped out. There is a kind of chronic inflammatory situation that occurs when this happens on the surface of a breast implant, and the body's response is to thicken the natural scar tissue that occurs around the implant (called the "capsule"). This thickening is called "capsular contracture" and it can make the implant (and the breast) feel firm, or even hard. In more advanced contractures, there may even be shape changes and pain. In these cases, the only real treatment is to remove the implant and the surrounding capsule (capsulectomy) and a new implant can be placed in the pocket at that time. Because this is a potentially serious complication of breast implants, a lot of time has been spent on trying avoid it, but contracture rates remain in the 10 to 30% range.How do the bacteria enter the pocket and create this biofilm on the implant? Possibly contamination at the time of surgery. Even though the skin has been prepped and should be sterile in the surgical procedure, there may be bacteria beneath the surface of the skin or in the lactiferous ducts that run through the breast tissue, especially near the nipple and areola. Many plastic surgeons have begun limiting their incisions to beneath the breast and have adopted a "no touch" technique where the implant is placed through a sterile sleeve into the pocket, so it won't touch the wound edges or skin. Additionally, the use of triple antibiotic solutions to irrigate the pocket and IV antibiotics during the procedure are commonplace to avoid infection and capsular contracture. The use of a class of allergy drugs called "leukotriene inhibitors" has also been employed in the fight against contractures.I have never seen a biofilm developing in the presence of a filler like Juvederm, so it is difficult to say if you are at higher risk. I would venture to say it is unlikely that this predisposes you to a capsular contracture. I would simply have the conversation with your plastic surgeon regarding your concerns, and make sure that surgeon is taking all the necessary precautions.

I must be honest with you, I think the notion of this biofilm seems to be overhyped and is really just fancy speak.  If you want the lowest chance of capsular contracture,  go with smooth saline implants under the muscle.  Saline implants have far less risk of contracture than silicone, though many plastic surgeons don't necessarily agree on this. Other than this, plastic surgeons still truly don't know the exact cause of capsular contracture, even after all these years.  The cause or causes are pure speculation.

Hello,Granulomatous lumps from filler (biofilm) are usually due to inadequate skin cleansing prior to injection.  Similarly, capsular contracture is most commonly due to ignoring basic facts: nipples and milk ducts are colonized with bacteria, not just skin. Your risk of capsular contracture with specialists that abide by the rules established by data is 1%.  These rules include: biodimensional planning of your implant, inframammary incision, covering the nipples during surgery, all electrocautery dissection, triple antibiotic irrigation of pockets with half strength Betadine, and delivery of implants with a funnel. Best of luck!

Thank you for your question.The exact science behind biofilms is not entirely understood, however, we believe biofilms arise from microorganisms on the surface of the implant, that causes inflammation and scar tissue to envelope the breast implant, and then capsular contracture. Some believe it is related to a subclinical infection. here are several ways to help prevent capsular contracture, such as "no touch technique" for inserting the breast implant, placing the implant in a submuscular/dual plane versus subglandular plane, using antibiotic irrigation, not utilizing a nipple incision to place the implant. Typically, biofilms do not occur with Juvederm injection--perhaps just a mild infection--especially since Juvederm is not permanent. And you are not at increased risk of contracture in the breasts because of what occurred with your lips.I recommend seeing a board certified plastic surgeon for your breast augmentation.Good luck!

Breast implant biofilms are a nuisance in plastic surgery because they are hard to treat and can last for a long time even if implants are removed. The best way to avoid the formation of biofilm is to maintain absolute sterility during your procedure and to minimize any contact with the implant when placing it into the correct pocket. There are certain steps that can also be added to protect against biofilm formation such as antibiotic solution irrigation or using a hands-free funnel device to place the implant. In the long-run, susceptible patients should also be on prophylactic antibiotics when undergoing certain procedures such as dental cleanings which can dislodge and cause bacteria to enter the bloodstream and adhere to implants in the body. Contractures can certainly occur with biofilms, but can also be caused by irritation by blood, or randomly with no apparent reason at all. Your complication with lip filler should not have any influence going forward with breast implants as long as there is no longer any active infection. Best of luck!

If you developed an infection after Juvederm, it probably had nothing to do with a biofilm, but, instead, injection technique. It could also have something to do with your immune system, as infection after filler injection appears to be quite rare even with poor technique. Because of your experience, I would not abandon your breast augmentation. I would, however, strongly recommend that you choose only a board certified plastic surgeon for the procedure. This assures 2 things. First, you will have a surgeon who understands everything that is necessary to prevent biofilms. You will also be operated on in an accredited facility that has met very stringent requirements regarding how the procedures are done and sterility precautions that are taken (all board certified plastic surgeons and those who are members of the American Society of Plastic Surgeons or the American Society for Aesthetic Plastic Surgery are required to operate only in accredited facilities). I would also suggest you discuss your concerns and history with your surgeon.

I have never heard of a biofilm associated with Juvederm or Restylane injection.  I'd like to see any documentation confirming that diagnosis since I'm skeptical that it even occurs.  Proper handling of the implant prior and during insertion (we recommend and use the Keller Funnel Device) and a strict regimen aimed at avoiding early capsule contracture following the procedure give you the best chance of avoidance of CC but no one can guarantee you that it won't occur.  If you have confidence in your surgeon follow his/her recommendations carefully and be certain to avoid the use of all blood thinners.You might also find the video above of interest.  Enjoy your results and best of luck....
Jon A Perlman MD FACS
Certified, Am Board of Plastic Surgery
Member, Am. Society for Aesthetic Plastic Surgery (ASAPS)
Beverly Hills, Ca

Dear Ms. Cranberrywhirl,Thank you for your questions.Biofilm is a only one of the causes of capsular contracture.Biofilm (adherent bacterial) resulting a subclinical (unnoticeable) contamination/infection which causes a chronic state of inflammation stimulating scar tissue.I have never heard of "biofilm" with a Juvederm injection. Since biofilm presents as a subclinical entity, how what you know?Are you sure you didn't have a infection? Never the less, the following is my view and what I do to prevent capsular contracture.Prevention of capsular I believe has three parts:I. SURGEON1) sub muscular placement2) use of textured implant (has other limitations)3) access incision: inframammary (breast crease)4) intra operative contamination (prevention of biofilm):A) changing non powdered gloves prior to insertion (use of Keller funnel)B) physical skin barriers (op site over breast and incision site)C) minimal to non touching of the implant5) intraoperative irrigation of breast pocket with triple antibiotic solution6) pre and post surgical antibiotics 7) gentle handling of tissue8) precise hemostasis (no blood left behind) PATIENT1) decolonization: minimum a Antimicrobial scrub of breasts night before and morning of surgery and topical antibiotics 2) avoidance of any smoking (first or second hand)3) regular displacement exercises of breast implants4) limited antibiotic coverage prior to future major dental procedures or surgery.5) avoidance of medications prior to surgery that can lead to bleeding or oozing (Aspirin, Motrin, Alleve , etc)GENETICS1) certain individuals can do all of the above and still acquire a capsular contracture.2) certain individuals can skip all of the above and not acquire a capsular contracture.I recommend that you make several consultative appointments with Plastic Surgeons who are experienced and Certified by the American Board of Plastic Surgery. In addition ideally they are members of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).I wish you my best and success,R. A. Hardesty, MD, FACSDiplomate and Certified by the Am. Bd. of Plastic Surgerywwwimagineplasticsurgery.com4646 Brockton AveRiverside, Ca 92506(951) 686-7600