Association Between Breast Microbiota and Capsular Contracture: A Systematic Review

Abstract Background Capsular contracture (CC), a common complication of breast implants, has an unclear etiology. Subclinical infection around the implant is widely considered a potential cause. Microorganisms, such as Staphylococcus epidermidis, have been associated with capsular contracture, but the specific role of bacteria from the breast capsule, glandular tissue, or skin remains unclear. No molecular studies have definitively investigated this association. Objectives This systematic review aimed to evaluate the relationship between breast microbiota, bacterial biofilms, and capsular contracture in patients undergoing cosmetic or reconstructive breast augmentation. Methods Data were extracted from studies identified through different search engines including Medline and Embase. Inclusion criteria focused on patient, surgical, and implant-related factors influencing capsular contracture. Only English-language articles were considered. Results The review included 428 women (453 breast implants) aged 27–53 years, with an average age of 31. Most studies lacked detailed reporting on implant characteristics or surgical techniques. The majority employed cell culture or pathology for microbiota assessment, with one study using PCR. Frequently identified bacteria included Staphylococcus epidermidis, Propionibacterium acnes, and Streptococcus spp. Conclusions This systematic review of 428 women with 453 breast implants found that Staphylococcus epidermidis, Propionibacterium acnes, and Streptococcus spp. were the most frequently isolated microorganisms in capsular contracture cases. The majority of studies used cell culture or pathology for microbiota assessment, with one employing PCR. Bacterial biofilm, particularly involving S. epidermidis, was consistently reported in contracted capsules, suggesting a strong association between specific breast microbiota and capsular contracture.