Hindawi Publishing Corporation BioMed Research International Volume 2013, Article ID 254940, 6 pages http://dx.doi.org/10.1155/2013/254940 Research Article Microbial Biofilms and Breast Tissue Expanders Melissa J. Karau, 1 Kerryl E. Greenwood-Quaintance, 1 Suzannah M. Schmidt, 1 Nho V. Tran, 2 Phyllis A. Convery, 2 Steven R. Jacobson, 2 Uldis Bite, 2 Ricky P. Clay, 2 Paul M. Petty, 2 Craig H. Johnson, 2 Jayawant Mandrekar, 3 and Robin Patel 1,4 1 Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, MN 55905, USA 2 Division of Plastic Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA 3 Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN 55905, USA 4 Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA Correspondence should be addressed to Robin Patel; patel.robin@mayo.edu Received 3 January 2013; Revised 20 May 2013; Accepted 13 June 2013 Academic Editor: Sheila Patrick Copyright © 2013 Melissa J. Karau et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We previously developed and validated a vortexing-sonication technique for detection of bioflm bacteria on the surface of explanted prosthetic joints. Herein, we evaluated this technique for diagnosis of infected breast tissue expanders and used it to assess colonization of breast tissue expanders. From April 2008 to December 2011, we studied 328 breast tissue expanders at Mayo Clinic, Rochester, MN, USA. Of seven clinically infected breast tissue expanders, six (85.7%) had positive cultures, one of which grew Propionibacterium species. Fify-two of 321 breast tissue expanders (16.2%, 95% CI, 12.3–20.7%) without clinical evidence of infection also had positive cultures, 45 growing Propionibacterium species and ten coagulase-negative staphylococci. While vortexing-sonication can detect clinically infected breast tissue expanders, 16 percent of breast tissue expanders appear to be asymptomatically colonized with normal skin fora, most commonly, Propionibacterium species. 1. Introduction In 2011, 96,277 breast reconstructions using breast tissue expanders were performed in the United States of America by American Society of Plastic Surgeons members [1]. Breast tissue expanders expand skin overlying a mastectomy site, facilitating subsequent implantation of a breast implant. Propionibacterium species are part of the normal fora of the skin, generally considered nonpathogenic, commensal anaerobic bacteria in sebaceous glands of the skin, although clinical infections can occur [2]. Propionibacterium acnes and Staphylococcus epidermidis, another skin commensal organ- ism, are endogenous breast fora, even in tissue located deep in the gland away from the nipple [3, 4], as a result of their accessing deep breast tissue via the central and intralobular ductal system [3]. Mastectomy surgery anatomically disturbs mammary ducts. Expanders are placed into the breast pocket, usually submuscularly, and gradually expanded over time using interval saline injections administered via a subcuta- neous port. Te injection port is located close to the shoulder and axillary regions, the normal skin and sebaceous gland fora of which includes P. acnes and S. epidermidis [2, 5], which are found in higher concentrations on the skin in these regions than on other areas of the body, such as hips or knees [2]. S. epidermidis and P. acnes have been associated with capsular contracture of breast implants. In a pilot study performed by our group using vortexing-sonication of breast implants, 33% (9/27) of implants removed due to capsular contracture had signifcant bacterial growth compared to 5% (1/18) of removed implants without capsular contracture ( = 0.034)[6]. Propionibacterium species and coagulase- negative staphylococci were the most common organisms found. Rieger et al. recently published a larger study using