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

Plast Reconstr Surg. 2016 Jun;137(6):1659-1669. doi: 10.1097/PRS.0000000000002010.


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.

Publication types

  • Multicenter Study

MeSH terms

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


  • DNA, Bacterial