Plastic and Reconstructive Surgery June 2016 -
Volume 137 - Issue 6 - p 1659–1669
Hu, H et al
Background: A recent association between breast implants and
the development of anaplastic large-cell lymphoma (ALCL) has been observed. The
purpose of this study was to identify whether bacterial biofilm is present in
breast implant–associated ALCL and, if so, to compare the bacterial microbiome
to nontumor capsule samples from breast implants with contracture. Methods:
Twenty-six breast implant–associated ALCL samples were analyzed for the
presence of biofilm by real-time quantitative polymerase chain reaction,
next-generation sequencing, fluorescent in situ hybridization, and scanning
electron microscopy, and compared to 62 nontumor capsule specimens. Results:
Both the breast implant–associated ALCL and nontumor capsule samples yielded
high mean numbers of bacteria (breast implant–associated ALCL, 4.7 × 106
cells/mg of tissue; capsule, 4.9 × 106 cells/mg of tissue). Analysis of the
microbiome in breast implant–associated ALCL specimens showed significant
differences with species identified in nontumor capsule specimens. There was a
significantly greater proportion of Ralstonia spp. present in ALCL specimens
compared with nontumor capsule specimens (p < 0.05). In contrast,
significantly more Staphylococcus spp. were found associated with nontumor
capsule specimens compared with breast implant–associated ALCL specimens (p
< 0.001). Bacterial biofilm was visualized both on scanning electron
microscopy and fluorescent in situ hybridization. Conclusions: This novel
finding of bacterial biofilm and a distinct microbiome in breast
implant–associated ALCL samples points to a possible infectious contributing
cause. Breast implants are widely used in both reconstructive and aesthetic
surgery, and strategies to reduce their contamination should be more widely
studied and practiced.
