Ozlem Gundeslioglu

Nanobacteria and breast implant capsule contracture and calcification: a hypothesis.

Capsule contracture is the most common and frustrating complication of augmentation mammoplasty [4]. A number of factors including foreign body reactions, hematomas, periprosthetic infections, and chronic inflammatory cells have been suggested as the etiology of capsule contracture. Increased collagen production by activated fibroblasts in contracted breast capsules has been demonstrated [3]. However the mechanism for the development of contracture and calcification around the implant remains unclear. Calcification of soft tissues, termed ‘‘pathologic calcification,’’ is common in atherosclerotic arteries and synthetic biomaterials (aortic replacements and porcine heart valves). This kind of calcification also has been observed in breast capsules, both macroscopically and microscopically. It results from accumulation of calcium and phosphate crystals [2]. However, the mechanism of the calcification remains speculative. Nanobacteria, the smallest cell-walled bacteria, and only recently discovered in human and cow blood and commercial cell culture serum, have been hypothesized to mediate tissue calcifications [5]. Biomineralization in cell culture media has resulted in biofilms and mineral aggregates closely resembling those found in tissue calcification and kidney stones. Moreover, nanobacteria have been shown to infect fibroblasts, resulting in intraand extracellular calcification and even stone formation in vivo [5]. Because nanobacteria infect fibroblasts, it might be possible for nanobacteria to increase collagen formation by activating fibroblasts, resulting in breast implant capsule contracture. The presence of biofilms in culture-negative breast capsules may be explained by nanobacteria, which are not detected normally by standard microbiologic methods [1]. Given the aforementioned information, we propose that nanobacteria may be associated with the development of breast implant capsule contracture and calcification. This proposal needs to be validated in the clinical and preclinical setting.