734 Understanding the Role of Bacterial Biofilm in Breast Implant Illness

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Abstract Aim Breast implant illness (BII) is an emerging clinical entity characterised by systemic symptoms such as fatigue, musculoskeletal pain, and cognitive dysfunction. Despite its rising recognition, the pathophysiology remains poorly understood, creating challenges for diagnosis and treatment. Biofilm infections, a well-documented complication of implanted medical devices, may provide a crucial insight into the etiology of BII. Method This retrospective review analysed 150 patients treated over a three-year period with breast implant removal and total capsulectomy for suspected BII. Standardised microbiological and pathological evaluations were performed on all explanted implants and surrounding capsules to detect bacterial biofilms. Symptom data were collected pre- and post-operatively using patient surveys, and changes in symptomology were statistically assessed. Results Microbiological analysis revealed bacterial biofilm in 55–60% of implants, a finding consistent with chronic low-grade infection. Post-operative surveys indicated that the vast majority of patients experienced significant symptom improvement following explantation. These findings strongly support the hypothesis that bacterial biofilms play a central role in BII pathogenesis. Conclusions Our study provides robust evidence linking bacterial biofilms to the systemic symptoms observed in BII. This association not only advances understanding of BII etiology but also underscores the therapeutic importance of explantation with capsulectomy. These insights may shape patient counselling, influence surgical decision-making, and advocate for broader insurance coverage of explantation procedures. Future research is needed to explore biofilm mitigation strategies to reduce BII risk.

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