Pilot Study: Investigating the Local Breast Microbiome in Implant-based Breast Reconstruction Using 16S rRNA Sequencing.

Background: Prior studies have used 16S rRNA sequencing to examine and define the local breast microbiome, but this has not been investigated with respect to breast reconstruction. Periexpander fluid can be readily collected in patients with a dual-port tissue expander, which could allow us to define the local breast microbiome at any given time point. This study aimed to determine the feasibility of obtaining microbiome data from periexpander fluid and explore its potential relevance for clinical implant infections.

Methods: We designed a pilot study including patients undergoing mastectomy with 2-stage implant-based reconstruction using dual-port tissue expanders. The periexpander fluid was obtained by accessing the aspiration port during standard postoperative visits, and this fluid was stored in a 1:1 ratio with DNA/RNA shield at -20°C. The microbiome of each sample was defined using 16S rRNA microbiome sequencing.

Results: Intraoperative and postoperative samples from 10 patients were sequenced to determine the feasibility of obtaining microbiome data from the periexpander aspirates. We were successful in obtaining microbiome data from all aspirates. Our results indicate that there are a large range of genera represented, but several genera appear to be more pervasive, including Pseudomonas, Corynebacterium, Phenylobacterium, Acinetobacter, and Staphylococcus.

Conclusions: We found that it is feasible to perform microbiome sequencing of breast tissue and periexpander aspirates to define the local breast environment. Rather than focusing on eliminating bacteria, it is critical to learn more about how we can optimize the balance of microorganisms in the breast microbiome to minimize infection risk.