Grants We Funded

Abstract
The long-term objective of this project is to differentiate virulent from clinically benign bacteria found on breast implants and then develop therapeutics to treat implant failure. We will focus on two clinical situations where bacteria may cause breast implants to fail – breast reconstruction with tissue expanders, and breast implant associated anaplastic large cell lymphoma (BIA-ALCL). Recent evidence shows that the breast parenchyma has a unique bacterial microbiome whose composition may be impacted by a breast cancer diagnosis. Further, some bacteria implicated in breast implant pathology may be resistant to antibiotic pocket irrigation used to limit bacterial contamination. In AIM 1, we prospectively identify bacterial reservoirs that colonize breast prostheses with or without triple-antibiotic pocket irrigation in staged prosthetic breast reconstruction following therapeutic and prophylactic mastectomies. Women undergoing removal of both breasts, one to treat and the other to prevent cancer, followed by placement of tissue expanders will be evaluated. We will define and compare the constituents of bacterial communities between cancer and non-cancer sides, antibiotic irrigation treated and untreated patients, and between tissue and implant specimens at the time of mastectomy versus breast implant exchange. In AIM 2, we identify potential reservoirs of bacteria colonizing breast implants and capsules in patient with BIA-ALCL. We will use 16S rRNA sequencing to characterize bacterial communities on breast tissue and implants. In addition, we will use infrared scanning to image large surface areas of the breast implant and capsule to minimize the impact of sampling bias, which plagues previous studies. We will also study proteins that coat breast implant surfaces like fibrinogen, fibronectin, and collagen. Previous work shows that these proteins serve as anchors to which several bacterial species adhere to form a bacterial community, or biofilm. Disruption of the binding interaction between these proteins and bacteria with rationally designed molecules, which we have already designed to treat urinary tract infections, could represent the next generation of therapeutics to prevent bacterial pathology on breast implants. Recognizing that hundreds of thousands of breast implants are placed annually, strategies to improve their safety by reducing infection, capsular contracture, or BIA-ALCL would have profound impact.

Biography
I received my undergraduate, medical school and preliminary general surgery training at the University of British Columbia before completing a plastic surgery residency and peripheral nerve research fellowship at Barnes Hospital/Washington University. I have received competitive research awards by the American College of Surgeons and American Association of Plastic Surgeons and was promoted to Professor at Washington University. My research background transitioned from studying nerve regeneration basic science to clinical outcomes research in breast reconstruction and cosmetic surgery, reflecting my clinical practice. My recent studies include a multicenter study, funded by the Plastic Surgery Foundation examining the clinical impact of fat transfer on breast cancer recurrence, and a randomized prospective trial examining the impact of incision location on clinical and patient reported outcomes in women undergoing nipple-sparing mastectomy with implant-based breast reconstruction. A key area of my research is examining the microbiome associated with reconstructive and cosmetic breast implants. I reported on the diverse microbiome causing breast implant infections at our facility and studied the impact of acellular dermal matrices on bacterial biofilms in reconstructive breast implant surgery. I have established a collaboration with Dr. Scott Hultgren, a world-expert in infectious disease in women, here at Washington University to advance this field in plastic surgery.