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Plast Reconstr Surg. 2016 Jun;137(6):1659-69. doi: 10.1097/PRS.0000000000002010.

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

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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.



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.


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.


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.


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.


Risk, V.

[Indexed for MEDLINE]

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