Grants Funded

Abstract

Impact Statement: We expect this research to lead us to a better understanding of the relationships between the breast and gut microbiomes, breast cancer, and post-operative implant infection. We also expect that our investigation will allow us to better understand how antibiotic regimens affect an individual's breast and gut microbiomes, and how this impacts implant infection rates. Using the data gathered and analyzed in this study, we foresee a future in which we would be able to use microbiome data to provide a form of personalized medicine, guiding us in decisions on breast reconstruction techniques and antibiotic prescribing practices best suited to each individual.

Project Summary: The goal of this project is to determine the roles of the breast microbiome, gut microbiome, and antibiotics in the development of implant infections in patients undergoing mastectomy with implant-based breast reconstruction. Various microbiomes throughout the body have been implicated in the development of certain cancers. The gut microbiome in particular has been a focus of study as it relates to breast cancer, and prior studies have illuminated various pathways through which the gut microbiome interacts with the factors involved in the development of breast cancer. Far less investigated is the local breast microbiome as it relates to breast cancer. Even fewer studies have attempted to study the local breast microbiome as it relates to the reconstructive process with issues such as implant infection. Additionally, the correlations between various microbiome environments in the body have not been elucidated. In this study, we aim to investigate the breast and gut microbiomes in breast cancer patients undergoing mastectomy with staged tissue expander implant-based reconstruction. We are particularly interested in how these microbiomes are related to the development of post-operative implant infection, and how antibiotics impact these microbiomes. We propose to use intra-operative specimens, fluid aspirated from the peri-expander space, and drain fluid as samples of the local breast microbiome. We will also be collecting samples from the gut microbiomes at defined time points for each patient. The patients will be randomized to one of two groups: one group will receive at least 7 days of post-operative antibiotics while the other group will receive only 24 hours of peri-operative antibiotics. This will allow us to investigate the impact of antibiotics on the gut and breast microbiomes. The primary endpoint in this study is the development of clinically significant infection within 90 days. Our central hypothesis is that the gut and breast microbiomes are unique in patients who develop infections after implant-based reconstruction. We also hypothesize that these microbiomes are impacted by antibiotics. The rationale for the proposed research is that once it is known how certain variances in these microbiomes increase the risk for post-operative infections, and once it is known how antibiotics change these microbiomes, we can manipulate these environments to decrease the rate of post-operative implant infections, thereby optimizing patient outcomes.

Biography
I am currently a third-year resident in the UCSF Integrated Plastic Surgery Residency Program, and will begin my research fellowship in the summer of 2021. Prior to pursuing a career in medicine, I completed a degree in biomedical engineering at Duke University. After graduating, I then worked as a project manager for Epic, the widely-used electronic medical record company. Over the course of my residency, my research interests have become focused in breast reconstructive surgery. In the two and a half years since I have been at UCSF, I have been involved in a number of projects investigating outcomes in breast reconstruction and transgender top surgery. My work in breast reconstruction will be presented at the San Antonio Breast Cancer Symposium annual meeting in December, 2020. My work in transgender top surgery has been presented at the California Society of Plastic Surgeons and American Society of Plastic Surgeons annual meetings, and two manuscripts in the field are currently submitted to Plastic and Reconstructive Surgery. I intend to use my research fellowship specifically to investigate the local breast microbiome and it’s interplay with the gut microbiome, antibiotic usage, and implant infections in women with breast cancer. I believe this work has the potential to provide us with meaningful data which will translate into clinically relevant, actionable changes in how we provide care for our breast cancer patients who undergo breast reconstruction.