Response to “Comments on ‘Characterizing the Microbiome of the Contracted Breast Capsule Using Next Generation Sequencing’” Free

We thank the authors¹ for their interest in our paper² and welcome the opportunity to respond to their question about why microbiome data from normal capsules were not included in our paper.

We designed our study to evaluate the application of next generation sequencing (NGS) as a diagnostic tool in our clinical practice. Our interest in this topic began after noticing a smell—a “musty odor”—during capsulectomy in some of our patients with capsular contracture. After traditional culture methods failed to reveal a causative organism, we turned to MicroGenDX and its NGS technique to gain a better understanding of what was happening.

Early in our experience with NGS we did send a few samples of normal breast tissue (taken during mastopexy or breast reduction), and these all came back NGS negative, indicating that no organisms were detected. We discussed these results with MicroGenDX and learned that there is a threshold of approximately 10³ CFU/mL for its NGS technique. For this reason, we believe that the quantity of resident flora in nonpathologic specimens was simply too low for detection. Although we have not yet sampled nonpathologic capsular tissue, we would anticipate subthreshold microbial concentrations here as well. We have been in discussion with MicroGenDX about the possible reasons for the negative NGS samples that we reviewed in our paper,² in the hopes the company can further enhance the sensitivity of its NGS process.

At levels of microorganisms below 10³ CFU/mL, other detection mechanisms would currently be more informative, but also more time-consuming, cost-prohibitive, and limited to research laboratories. We believe that NGS shows the greatest promise as a tool for evaluating contracted breast capsules in clinical practice. This technology is currently available to every plastic surgeon practicing in the United States, and likely internationally in the future.

Disclosures

The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Funding

The authors received no financial support for the research, authorship, and publication of this article

REFERENCES

Author notes