Bacterial Biofilm Infection Detected in Breast Implant-Associated Anaplastic Large-Cell Lymphoma.

Abstract

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 × 10 cells/mg of tissue; capsule, 4.9 × 10 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.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, V.

• Authors: Honghua Hu, Khalid Johani, Ahmad Almatroudi, Karen Vickery, Bruce Van Natta, Marshall E Kadin, Garry Brody, Mark Clemens, Chan Yoon Cheah, Stephen Lade, Preeti Avinash Joshi, H Miles Prince, Anand K Deva
• Journal: Plastic and reconstructive surgery (Plast Reconstr Surg) Vol. 137 Issue 6 Pg. 1659-1669 (Jun 2016) ISSN: 1529-4242 [Electronic] United States
• PMID: 26890506 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• DNA, Bacterial

Topics

• Adult
• Aged
• Bacteria (genetics, isolation & purification)
• Bacterial Load
• Biofilms
• Breast Implants (microbiology)
• DNA, Bacterial (analysis)
• Female
• Humans
• In Situ Hybridization, Fluorescence
• Lymphoma, Large-Cell, Anaplastic (diagnosis, microbiology)
• Male
• Mammaplasty (adverse effects)
• Microscopy, Electron, Scanning
• Middle Aged
• Prosthesis-Related Infections (diagnosis, microbiology)
• Real-Time Polymerase Chain Reaction