Insights into the Microbiome of Breast Implants and Periprosthetic Tissue in Breast Implant-Associated Anaplastic Large Cell Lymphoma

Jennifer N Walker,Scott J Hultgren,Rajiv Parikh,Shelby R Simar,Chloe L Pinkner,Mark W Clemens,Blake M Hanson,Jerome S Pinkner,Terence M Myckatyn

doi:10.1038/s41598-019-46535-8

Abstract

Though rare, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a CD30+ T-cell lymphoma associated with textured breast implants, has adversely impacted our perception of the safety of breast implants. Its etiology unknown, one hypothesis suggests an initiating inflammatory stimulus, possibly infectious, triggers BIA-ALCL. We analyzed microbiota of breast, skin, implant and capsule in BIA-ALCL patients (n = 7), and controls via culturing methods, 16S rRNA microbiome sequencing, and immunohistochemistry. Alpha and beta diversity metrics and relative abundance of Gram-negative bacteria were calculated, and phylogenetic trees constructed. Staphylococcus spp., the most commonly cultured microbes, were identified in both the BIA-ALCL and contralateral control breast. The diversity of bacterial microbiota did not differ significantly between BIA-ALCL and controls for any material analyzed. Further, there were no significant differences in the relative abundance of Gram-negative bacteria between BIA-ALCL and control specimens. Heat maps suggested substantial diversity in the composition of the bacterial microbiota of the skin, breast, implant and capsule between patients with no clear trend to distinguish BIA-ALCL from controls. While we identified no consistent differences between patients with BIA-ALCL-affected and contralateral control breasts, this study provides insights into the composition of the breast microbiota in this population.

Highlights

IC may explain why only women who had textured implants developed BIA-ALCL10–12
In the current study we perform a detailed analysis of the bacterial microbiota across several sites within the implanted breasts of patients with unilateral BIA-ALCL
When samples were stratified by material and BIA-ALCL samples were compared to control samples, we found that Propionibacterium was the largest driver of variability as calculated using the Bray-Curtis dissimilarity matrix[20], with Staphylococcus, Altererythrobacter, and Stenotrophomonas contributing to the observed variability, not across all sample types (Fig. 5)

Summary

Introduction

Ralstonia spp, a Gram-negative microorganism, has been identified in an unexpectedly high proportion of BIA-ALCL specimens[7]. Confirmation of a causative link between bacterial infection and BIA-ALCL, remains elusive[7,13]. In the current study we perform a detailed analysis of the bacterial microbiota across several sites within the implanted breasts of patients with unilateral BIA-ALCL. The goals of this study were to i) determine whether the bacterial species colonizing the BIA-ALCL complicated and contralateral control devices were different and ii) whether those same species could be found colonizing the breast environment, which may provide insights into how these devices initially become colonized. Differences in microbial diversity, the bacteria present, and the relative abundance of bacteria, including Ralstonia spp, were analyzed and compared between BIA-ALCL and contralateral control sides

Objectives

Methods

Results

Discussion

Conclusion