title: 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.
  
  
  METHODS
  Risk, V.
authors.affiliation: 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.
authors.forename: Honghua
authors.initials: H
authors.lastname: Hu
authors.affiliation: 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.
authors.forename: Khalid
authors.initials: K
authors.lastname: Johani
authors.affiliation: 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.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Almatroudi
authors.affiliation: 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.
authors.forename: Karen
authors.initials: K
authors.lastname: Vickery
authors.affiliation: 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.
authors.forename: Bruce
authors.initials: B
authors.lastname: Van Natta
authors.affiliation: 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.
authors.forename: Marshall E
authors.initials: ME
authors.lastname: Kadin
authors.affiliation: 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.
authors.forename: Garry
authors.initials: G
authors.lastname: Brody
authors.affiliation: 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.
authors.forename: Mark
authors.initials: M
authors.lastname: Clemens
authors.affiliation: 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.
authors.forename: Chan Yoon
authors.initials: CY
authors.lastname: Cheah
authors.affiliation: 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.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lade
authors.affiliation: 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.
authors.forename: Preeti Avinash
authors.initials: PA
authors.lastname: Joshi
authors.affiliation: 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.
authors.forename: H Miles
authors.initials: HM
authors.lastname: Prince
authors.affiliation: 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.
authors.forename: Anand K
authors.initials: AK
authors.lastname: Deva
mesh_terms: D000328:Adult; D000368:Aged; D001419:Bacteria / Q000235:genetics / Q000302:isolation & purification*; D058491:Bacterial Load; D018441:Biofilms; D018427:Breast Implants / Q000382:microbiology*; D004269:DNA, Bacterial / Q000032:analysis; D005260:Female; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D017728:Lymphoma, Large-Cell, Anaplastic / Q000175:diagnosis / Q000382:microbiology*; D008297:Male; D016462:Mammaplasty / Q000009:adverse effects*; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology*; D060888:Real-Time Polymerase Chain Reaction
chemical_list: D004269:DNA, Bacterial