Chronic biofilm infection in breast implants is associated with an increased t-cell lymphocytic infiltrate: Implications for breast implant-associated lymphoma

Honghua Hu, Anita Jacombs, Karen Vickery, Steven L. Merten, David G. Pennington, Anand K. Deva

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: Biofilm infection of breast implants significantly potentiates capsular contracture. This study investigated whether chronic biofilm infection could promote T-cell hyperplasia. Methods: In the pig study, 12 textured and 12 smooth implants were inserted into three adult pigs. Implants were left in situ for a mean period of 8.75 months. In the human study, 57 capsules from patients with Baker grade IV contracture were collected prospectively over a 4-year period. Biofilm and surrounding lymphocytes were analyzed using culture, nucleic acid, and visualization techniques. Results: In the pig study, all samples were positive for bacterial biofilm. There was a significant correlation between the bacterial numbers and grade of capsular contracture (p = 0.04). Quantitative real-time polymerase chain reaction showed that all lymphocytes were significantly more numerous on textured compared with smooth implants (p < 0.001). T cells accounted for the majority of the lymphocytic infiltrate. Imaging confirmed the presence of activated lymphocytes. In the human study, all capsules were positive for biofilm. Analysis of lymphocyte numbers showed a T-cell predominance (p < 0.001). There was a significant linear correlation between the number of T and B cells and the number of detected bacteria (p < 0.001). Subset analysis showed a significantly higher number of bacteria for polyurethane implants (p < 0.005). Conclusions: Chronic biofilm infection around breast prostheses produces an increased T-cell response both in the pig and in humans. A possible link between bacterial biofilm and T-cell hyperplasia is significant in light of breast implant-associated anaplastic large-cell lymphoma.

    LanguageEnglish
    Pages319-329
    Number of pages11
    JournalPlastic and reconstructive surgery
    Volume135
    Issue number2
    DOIs
    Publication statusPublished - 2015

    Fingerprint

    Breast Implants
    Biofilms
    Lymphoma
    T-Lymphocytes
    Infection
    Contracture
    Swine
    Lymphocytes
    Capsules
    Hyperplasia
    Bacteria
    Anaplastic Large-Cell Lymphoma
    Polyurethanes
    Lymphocyte Count
    Nucleic Acids
    Prostheses and Implants
    Real-Time Polymerase Chain Reaction
    Breast
    B-Lymphocytes
    Cell Count

    Cite this

    @article{f7eb7d04f9854889bba690de0a814680,
    title = "Chronic biofilm infection in breast implants is associated with an increased t-cell lymphocytic infiltrate: Implications for breast implant-associated lymphoma",
    abstract = "Background: Biofilm infection of breast implants significantly potentiates capsular contracture. This study investigated whether chronic biofilm infection could promote T-cell hyperplasia. Methods: In the pig study, 12 textured and 12 smooth implants were inserted into three adult pigs. Implants were left in situ for a mean period of 8.75 months. In the human study, 57 capsules from patients with Baker grade IV contracture were collected prospectively over a 4-year period. Biofilm and surrounding lymphocytes were analyzed using culture, nucleic acid, and visualization techniques. Results: In the pig study, all samples were positive for bacterial biofilm. There was a significant correlation between the bacterial numbers and grade of capsular contracture (p = 0.04). Quantitative real-time polymerase chain reaction showed that all lymphocytes were significantly more numerous on textured compared with smooth implants (p < 0.001). T cells accounted for the majority of the lymphocytic infiltrate. Imaging confirmed the presence of activated lymphocytes. In the human study, all capsules were positive for biofilm. Analysis of lymphocyte numbers showed a T-cell predominance (p < 0.001). There was a significant linear correlation between the number of T and B cells and the number of detected bacteria (p < 0.001). Subset analysis showed a significantly higher number of bacteria for polyurethane implants (p < 0.005). Conclusions: Chronic biofilm infection around breast prostheses produces an increased T-cell response both in the pig and in humans. A possible link between bacterial biofilm and T-cell hyperplasia is significant in light of breast implant-associated anaplastic large-cell lymphoma.",
    author = "Honghua Hu and Anita Jacombs and Karen Vickery and Merten, {Steven L.} and Pennington, {David G.} and Deva, {Anand K.}",
    year = "2015",
    doi = "10.1097/PRS.0000000000000886",
    language = "English",
    volume = "135",
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    Chronic biofilm infection in breast implants is associated with an increased t-cell lymphocytic infiltrate : Implications for breast implant-associated lymphoma. / Hu, Honghua; Jacombs, Anita; Vickery, Karen; Merten, Steven L.; Pennington, David G.; Deva, Anand K.

    In: Plastic and reconstructive surgery, Vol. 135, No. 2, 2015, p. 319-329.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Chronic biofilm infection in breast implants is associated with an increased t-cell lymphocytic infiltrate

    T2 - Plastic and reconstructive surgery

    AU - Hu,Honghua

    AU - Jacombs,Anita

    AU - Vickery,Karen

    AU - Merten,Steven L.

    AU - Pennington,David G.

    AU - Deva,Anand K.

    PY - 2015

    Y1 - 2015

    N2 - Background: Biofilm infection of breast implants significantly potentiates capsular contracture. This study investigated whether chronic biofilm infection could promote T-cell hyperplasia. Methods: In the pig study, 12 textured and 12 smooth implants were inserted into three adult pigs. Implants were left in situ for a mean period of 8.75 months. In the human study, 57 capsules from patients with Baker grade IV contracture were collected prospectively over a 4-year period. Biofilm and surrounding lymphocytes were analyzed using culture, nucleic acid, and visualization techniques. Results: In the pig study, all samples were positive for bacterial biofilm. There was a significant correlation between the bacterial numbers and grade of capsular contracture (p = 0.04). Quantitative real-time polymerase chain reaction showed that all lymphocytes were significantly more numerous on textured compared with smooth implants (p < 0.001). T cells accounted for the majority of the lymphocytic infiltrate. Imaging confirmed the presence of activated lymphocytes. In the human study, all capsules were positive for biofilm. Analysis of lymphocyte numbers showed a T-cell predominance (p < 0.001). There was a significant linear correlation between the number of T and B cells and the number of detected bacteria (p < 0.001). Subset analysis showed a significantly higher number of bacteria for polyurethane implants (p < 0.005). Conclusions: Chronic biofilm infection around breast prostheses produces an increased T-cell response both in the pig and in humans. A possible link between bacterial biofilm and T-cell hyperplasia is significant in light of breast implant-associated anaplastic large-cell lymphoma.

    AB - Background: Biofilm infection of breast implants significantly potentiates capsular contracture. This study investigated whether chronic biofilm infection could promote T-cell hyperplasia. Methods: In the pig study, 12 textured and 12 smooth implants were inserted into three adult pigs. Implants were left in situ for a mean period of 8.75 months. In the human study, 57 capsules from patients with Baker grade IV contracture were collected prospectively over a 4-year period. Biofilm and surrounding lymphocytes were analyzed using culture, nucleic acid, and visualization techniques. Results: In the pig study, all samples were positive for bacterial biofilm. There was a significant correlation between the bacterial numbers and grade of capsular contracture (p = 0.04). Quantitative real-time polymerase chain reaction showed that all lymphocytes were significantly more numerous on textured compared with smooth implants (p < 0.001). T cells accounted for the majority of the lymphocytic infiltrate. Imaging confirmed the presence of activated lymphocytes. In the human study, all capsules were positive for biofilm. Analysis of lymphocyte numbers showed a T-cell predominance (p < 0.001). There was a significant linear correlation between the number of T and B cells and the number of detected bacteria (p < 0.001). Subset analysis showed a significantly higher number of bacteria for polyurethane implants (p < 0.005). Conclusions: Chronic biofilm infection around breast prostheses produces an increased T-cell response both in the pig and in humans. A possible link between bacterial biofilm and T-cell hyperplasia is significant in light of breast implant-associated anaplastic large-cell lymphoma.

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    U2 - 10.1097/PRS.0000000000000886

    DO - 10.1097/PRS.0000000000000886

    M3 - Article

    VL - 135

    SP - 319

    EP - 329

    JO - Plastic and reconstructive surgery

    JF - Plastic and reconstructive surgery

    SN - 0032-1052

    IS - 2

    ER -