191. Improving Biofilm Prevention in Breast Surgery: Hyaluronic Acid as an Implant Submersion Adjunct

PURPOSE: Capsular contracture remains the most common complication of implant-based breast surgery. Although its etiology is not fully understood, research has suggested that biofilm formation on implant surfaces is a central contributing factor. Plastic surgeons have adopted risk-reducing measures such as intraoperative implant submersion and breast pocket irrigation with antimicrobials and antiseptics, but these practices are heterogenous, and capsule contracture rates remain high. Therefore, improving prophylactic methods is warranted. Recent studies have demonstrated the antibiofilm effects of hyaluronic acid on various surgical prostheses. Our study tested the in-vitro antibiofilm properties of hyaluronic acid as a potential adjunct to intraoperative breast implant submersion solutions. METHODS: Six-millimeter diameter silicone disks were cut from smooth tissue expanders and treated with varying concentrations of hyaluronic acid, with or without triple antibiotic solution (clindamycin 450 mg, cefazolin 1000 mg, gentamicin 80 mg per 500 mL). After submersion, the disks were incubated for 60 hours in tryptic soy broth inoculated with Staphylococcus epidermidis strain RP62A. The resulting biofilms were stained using crystal violet, and the dye was eluted for optical density analysis at 580 nanometer wavelengths. The resulting mean optical densities were compared to describe relative degrees of biofilm formation per treatment. RESULTS: Additive antibiofilm effects were observed in the treatment groups, with maximal inhibition reached when pretreated with 8 mg/mL hyaluronic acid in triple antibiotic solution, resulting in a mean dye optical density of 0.313. This value was significantly lower than both the positive control (mean optical density 2.549; p-value 1.44E-07) and the triple antibiotic solution alone (mean optical density 0.877; p-value 6.35E-05), representing respective reductions in biofilm formation of 87.7% and 64.3%. Hyaluronic acid alone exerted dose-dependent antibiofilm effects, with 12 mg/mL achieving a biofilm reduction similar to that of triple antibiotic solution. CONCLUSION: Hyaluronic acid shows promise as an adjunct to intraoperative triple antibiotic submersion solutions. Pretreatment of silicone disks with 8 mg/mL hyaluronic acid in triple antibiotic solution resulted in 87.7% and 64.3% relative biofilm reductions respective to the positive control and the triple antibiotic solution. These antibiofilm effects, combined with biocompatible, resorbable, chemically modifiable, and viscous properties make hyaluronic acid a strong candidate for in-vivo or clinical research for the prevention of capsular contracture in implant-based breast surgery.