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

Hu, Honghua, Ph.D.; Johani, Khalid; Almatroudi, Ahmad; Vickery, Karen, Ph.D., B.V.Sc.; Van Natta, Bruce, M.D.; Kadin, Marshall E., M.D.; Brody, Garry, M.D.; Clemens, Mark, M.D.; Cheah, Chan Yoon, M.D.; Lade, Stephen, M.D.; Joshi, Preeti Avinash, M.D., Ph.D.; Prince, H. Miles, M.D., Ph.D.; Deva, Anand K., B.Sc.(Med.), M.B.B.S., M.S.

Plastic and Reconstructive Surgery: June 2016 - Volume 137 - Issue 6 - p 1659-1669
doi: 10.1097/PRS.0000000000002010
Breast: Original Articles
Editor's Pick

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.


Boston, Mass.; Los Angeles, Calif.; Houston, Texas; Indianapolis, Ind.; Sydney, New South Wales, and Melbourne, Victoria, Australia; and Riyadh and Qassim, Kingdom of Saudi Arabia

From the Boston University School of Medicine and Roger Williams Medical Center; the University of Southern California; the University of Texas M. D. Anderson Cancer Center; Meridian Plastic Surgery; the Surgical Infection Research Group, Macquarie University, Peter MacCallum Cancer Center, University of Melbourne, and the Department of Allergy and Immunology, Children’s Hospital at Westmead; the Division of Microbiology, Prince Sultan Military Medical City, and the Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University.

Received for publication August 18, 2015; accepted November 19, 2015.

Disclosure:Dr. Deva and Dr. Vickery have coordinated research for Allergan, Mentor (Johnson & Johnson), and Acelity. Dr. Clemens has coordinated research for Allergan. The remaining authors have no financial interest to declare in relation to the content of this article.

Anand K. Deva, B.Sc.(Med.), M.B.B.S., M.S., Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Suite 301, 2 Technology Place, Macquarie University, Sydney, New South Wales, Australia,

Copyright © 2016 by the American Society of Plastic Surgeons