{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T15:44:20Z","timestamp":1792424660762,"version":"4.5.0"},"reference-count":41,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:00:00Z","timestamp":1790380800000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100005111","name":"Rigshospitalet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005111","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Foundation","doi-asserted-by":"publisher","award":["052198"],"award-info":[{"award-number":["052198"]}],"id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Foundation","doi-asserted-by":"publisher","award":["0058322"],"award-info":[{"award-number":["0058322"]}],"id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003554","name":"Lundbeck Foundation","doi-asserted-by":"publisher","award":["R413-2022-621"],"award-info":[{"award-number":["R413-2022-621"]}],"id":[{"id":"10.13039\/501100003554","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Subglandular implant placement and periareolar incisions have historically been associated with higher capsular contracture rates than subpectoral placement and inframammary fold (IMF) incisions. These differences have often been attributed to greater implant exposure to endogenous breast microbiota.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare microbiome diversity and composition on explanted breast implants between subpectoral and subglandular planes, and among IMF, periareolar, and transaxillary incisions, and assess whether greater parenchymal exposure is associated with persistent microbiome differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed explanted implants from patients undergoing revisional surgery after breast augmentation with 16S rRNA gene amplicon sequencing. We compared alpha and beta diversity and differential abundance of the dominant genera, adjusting for capsular contracture, implantation time, surface texture, smoking status, and within-patient clustering.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We analyzed 389 implants from 219 patients, of which 336 (86%) were subpectoral and 53 (14%) were subglandular. We did not detect differences between plane groups in alpha diversity (Shannon 1.7 vs 1.7, P adj = .62), community composition (PERMANOVA P adj = 0.46), or differential relative abundance of the dominant genera. In contrast, implants placed with a periareolar incision (n = 45) showed higher richness and a distinct composition compared with the IMF group (n = 308, Bray-Curtis P adj = .004), with no significant difference between IMF and transaxillary access (n = 36, P adj = .12).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We did not detect differences in relative microbiome diversity, community composition, or differential relative abundance of dominant genera between implant planes. In contrast, incision site was associated with consistent microbiome differences, suggesting that implantation route may influence the long-term implant microbiome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence: 3 (Diagnostic)<\/jats:title>\n                    <jats:p>For image description, please refer to the figure legend and surrounding text.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/asj\/sjag215","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T11:22:32Z","timestamp":1790335352000},"source":"Crossref","is-referenced-by-count":0,"title":["Breast Implant Microbiome Differs by Incision Site But Not by Implant Plane: An Analysis of 389 Explanted Implants"],"prefix":"10.1093","author":[{"given":"Tim K","family":"Weltz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuang","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Larsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1802-9153","authenticated-orcid":false,"given":"Erik E F","family":"Bak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John V Q","family":"Tran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda R","family":"Gudjonsdottir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon G","family":"Sabroe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline B G","family":"Norlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie R","family":"Mortensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8439-6537","authenticated-orcid":false,"given":"Mathilde N","family":"Hemmingsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias","family":"\u00d8rholt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise V","family":"Mielke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesper","family":"Trillingsgaard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens J","family":"Elberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisbet R","family":"H\u00f6lmich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa T","family":"Jensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Vester-Glowinski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8003-7414","authenticated-orcid":false,"given":"Thomas","family":"Bjarnsholt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1541-6212","authenticated-orcid":false,"given":"Urvish","family":"Trivedi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuanji","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark W","family":"Clemens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00f8ren J","family":"S\u00f8rensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5866-1173","authenticated-orcid":false,"given":"Mikkel","family":"Herly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,26]]},"reference":[{"key":"2026101911363841100_sjag215-B1","doi-asserted-by":"publisher","first-page":"81S","DOI":"10.1097\/00006534-200612001-00012","article-title":"Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types","volume":"118","author":"Tebbetts","year":"2006","journal-title":"Plast Reconstr Surg"},{"key":"2026101911363841100_sjag215-B2","doi-asserted-by":"publisher","first-page":"2202","DOI":"10.1097\/00006534-200005000-00047","article-title":"Breast augmentation: choosing the optimal incision, implant, and pocket plane","volume":"105","author":"Hidalgo","year":"2000","journal-title":"Plast Reconstr Surg"},{"key":"2026101911363841100_sjag215-B3","first-page":"49","volume-title":"Plastic Surgery","author":"Calobrace","year":"2018","edition":"4th ed."},{"key":"2026101911363841100_sjag215-B4","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.bjps.2026.04.026","article-title":"Postoperative complications after subpectoral versus prepectoral implant-based breast reconstruction: a target trial emulation study","volume":"117","author":"Drej\u00f8e","year":"2026","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"2026101911363841100_sjag215-B5","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1093\/asj\/sjaf012","article-title":"Silicone leakage from breast implants and its association with capsular contracture in 657 patients","volume":"45","author":"Larsen","year":"2025","journal-title":"Aesthet Surg J"},{"key":"2026101911363841100_sjag215-B6","doi-asserted-by":"publisher","first-page":"59e","DOI":"10.1097\/PRS.0000000000011938","article-title":"Transcriptome of capsular contracture around breast implants mimics allograft rejection: a matched case\u2013control study","volume":"156","author":"Larsen","year":"2025","journal-title":"Plast Reconstr Surg"},{"key":"2026101911363841100_sjag215-B7","doi-asserted-by":"publisher","first-page":"2714","DOI":"10.1007\/s00266-021-02473-3","article-title":"Histological analyses of capsular contracture and associated risk factors: a systematic review","volume":"45","author":"Larsen","year":"2021","journal-title":"Aesthetic Plast Surg"},{"key":"2026101911363841100_sjag215-B8","doi-asserted-by":"publisher","first-page":"1605","DOI":"10.1097\/01.PRS.0000054768.14922.44","article-title":"Detection of subclinical infection in significant breast implant capsules","volume":"111","author":"Pajkos","year":"2003","journal-title":"Plast Reconstr Surg"},{"key":"2026101911363841100_sjag215-B9","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1097\/PRS.0b013e3181e3b456","article-title":"Subclinical (biofilm) infection causes capsular contracture in a porcine model following augmentation mammaplasty","volume":"126","author":"Tamboto","year":"2010","journal-title":"Plast Reconstr Surg"},{"key":"2026101911363841100_sjag215-B10","doi-asserted-by":"publisher","first-page":"1319","DOI":"10.1097\/PRS.0b013e3182a3c105","article-title":"The role of bacterial biofilms in device-associated infection","volume":"132","author":"Deva","year":"2013","journal-title":"Plast Reconstr Surg"},{"key":"2026101911363841100_sjag215-B11","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1093\/asj\/sjv177","article-title":"The relationship of bacterial biofilms and capsular contracture in breast implants","volume":"36","author":"Ajdic","year":"2016","journal-title":"Aesthet Surg J"},{"key":"2026101911363841100_sjag215-B12","doi-asserted-by":"publisher","first-page":"1354","DOI":"10.1097\/PRS.0000000000000021","article-title":"Natrelle round silicone breast implants: core study results at 10 years","volume":"133","author":"Spear","year":"2014","journal-title":"Plast Reconstr Surg"},{"key":"2026101911363841100_sjag215-B13","doi-asserted-by":"publisher","first-page":"20S","DOI":"10.1097\/PRS.0000000000004351","article-title":"Risk factor analysis for capsular contracture: a 10-year Sientra study using round, smooth, and textured implants for breast augmentation","volume":"141","author":"Calobrace","year":"2018","journal-title":"Plast Reconstr Surg"},{"key":"2026101911363841100_sjag215-B14","doi-asserted-by":"publisher","first-page":"3979","DOI":"10.1007\/s00266-026-05706-5","article-title":"Implant pocket plane selection in primary breast augmentation: a meta-analysis and systematic review of complication profiles","volume":"50","author":"Alderhali","year":"2026","journal-title":"Aesthetic Plast Surg"},{"key":"2026101911363841100_sjag215-B15","doi-asserted-by":"publisher","first-page":"8S","DOI":"10.1097\/01.prs.0000286580.93214.df","article-title":"Inamed silicone breast implant core study results at 6 years","volume":"120","author":"Spear","year":"2007","journal-title":"Plast Reconstr Surg"},{"key":"2026101911363841100_sjag215-B16","doi-asserted-by":"publisher","first-page":"19S","DOI":"10.1097\/01.prs.0000286574.88752.04","article-title":"The Mentor core study on silicone MemoryGel breast implants","volume":"120","author":"Cunningham","year":"2007","journal-title":"Plast Reconstr Surg"},{"key":"2026101911363841100_sjag215-B17","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.1093\/asj\/sjv020","article-title":"Eight-year follow-up data from the U.S. clinical trial for Sientra's FDA-approved round and shaped implants with high-strength cohesive silicone gel","volume":"35","author":"Stevens","year":"2015","journal-title":"Aesthet Surg J"},{"key":"2026101911363841100_sjag215-B18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/PRS.0000000000002837","article-title":"Risk factor analysis for capsular contracture, malposition, and late seroma in subjects receiving Natrelle 410 form-stable silicone breast implants","volume":"139","author":"McGuire","year":"2017","journal-title":"Plast Reconstr Surg"},{"key":"2026101911363841100_sjag215-B19","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.1097\/01.prs.0000435317.76381.68","article-title":"Risk factor analysis for capsular contracture: a 5-year sientra study analysis using round, smooth, and textured implants for breast augmentation","volume":"132","author":"Stevens","year":"2013","journal-title":"Plast Reconstr Surg"},{"key":"2026101911363841100_sjag215-B20","doi-asserted-by":"publisher","first-page":"1165","DOI":"10.1016\/j.bjps.2013.04.046","article-title":"Primary breast augmentation clinical trial outcomes stratified by surgical incision, anatomical placement and implant device type","volume":"66","author":"Namnoum","year":"2013","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"2026101911363841100_sjag215-B21","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1007\/s00266-007-9061-2","article-title":"Relationship of incision choice to capsular contracture","volume":"32","author":"Wiener","year":"2008","journal-title":"Aesthetic Plast Surg"},{"key":"2026101911363841100_sjag215-B22","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1007\/s00266-017-0965-1","article-title":"Capsular contracture rate after breast augmentation with periareolar versus other two (inframammary and transaxillary) incisions: a meta-analysis","volume":"42","author":"Li","year":"2018","journal-title":"Aesthetic Plast Surg"},{"key":"2026101911363841100_sjag215-B23","doi-asserted-by":"publisher","first-page":"802","DOI":"10.1177\/1090820X11417428","article-title":"The breast: a clean-contaminated surgical site","volume":"31","author":"Bartsich","year":"2011","journal-title":"Aesthet Surg J"},{"key":"2026101911363841100_sjag215-B24","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1177\/1090820X12456841","article-title":"Risk of breast implant bacterial contamination from endogenous breast Flora, prevention with nipple shields, and implications for biofilm formation","volume":"32","author":"Wixtrom","year":"2012","journal-title":"Aesthet Surg J"},{"key":"2026101911363841100_sjag215-B25","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1016\/j.actbio.2025.11.008","article-title":"Breast implant microbiome profile correlates with foreign body response severity","volume":"208","author":"Weltz","year":"2025","journal-title":"Acta Biomater"},{"key":"2026101911363841100_sjag215-B26","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.actbio.2026.06.038","article-title":"Breast implant surface texture is associated with distinct implant microbiome profiles in humans","volume":"219","author":"Weltz","year":"2026","journal-title":"Acta Biomater"},{"key":"2026101911363841100_sjag215-B27","doi-asserted-by":"publisher","first-page":"NP391","DOI":"10.1093\/asj\/sjae050","article-title":"Development and validation of a diagnostic histopathological scoring system for capsular contracture based on 720 breast implant capsules","volume":"44","author":"Larsen","year":"2024","journal-title":"Aesthet Surg J"},{"key":"2026101911363841100_sjag215-B28","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1007\/s00266-024-04128-5","article-title":"A histological assessment tool for breast implant capsules validated in 480 patients with and without capsular contracture","volume":"49","author":"Larsen","year":"2025","journal-title":"Aesthetic Plast Surg"},{"key":"2026101911363841100_sjag215-B29","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1093\/asj\/sjae154","article-title":"The prevalence and histological characteristics of the double capsule phenomenon in breast augmentation with implants","volume":"45","author":"Bak","year":"2024","journal-title":"Aesthet Surg J"},{"key":"2026101911363841100_sjag215-B30","doi-asserted-by":"publisher","first-page":"504e","DOI":"10.1097\/PRS.0000000000012443","article-title":"Breast implant rupture is strongly associated with capsular contracture: an intrapatient study","volume":"157","author":"Bak","year":"2026","journal-title":"Plast Reconstr Surg"},{"key":"2026101911363841100_sjag215-B31","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1097\/00006534-199510000-00018","article-title":"Classification of capsular contracture after prosthetic breast reconstruction","volume":"96","author":"Spear","year":"1995","journal-title":"Plast Reconstr Surg"},{"key":"2026101911363841100_sjag215-B32","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1038\/nmeth.3869","article-title":"DADA2: high-resolution sample inference from Illumina amplicon data","volume":"13","author":"Callahan","year":"2016","journal-title":"Nat Methods"},{"key":"2026101911363841100_sjag215-B33","doi-asserted-by":"publisher","first-page":"852","DOI":"10.1038\/s41587-019-0209-9","article-title":"Reproducible, interactive, scalable and extensible microbiome data science using QIIME 2","volume":"37","author":"Bolyen","year":"2019","journal-title":"Nat Biotechnol"},{"key":"2026101911363841100_sjag215-B34","doi-asserted-by":"publisher","first-page":"D590","DOI":"10.1093\/nar\/gks1219","article-title":"The SILVA ribosomal RNA gene database project: improved data processing and web-based tools","volume":"41","author":"Quast","year":"2013","journal-title":"Nucleic Acids Res"},{"key":"2026101911363841100_sjag215-B35","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0061217","article-title":"Phyloseq: an R package for reproducible interactive analysis and graphics of microbiome census data","volume":"8","author":"McMurdie","year":"2013","journal-title":"PLoS One"},{"key":"2026101911363841100_sjag215-B36","doi-asserted-by":"publisher","DOI":"10.1186\/s40168-018-0605-2","article-title":"Simple statistical identification and removal of contaminant sequences in marker-gene and metagenomics data","volume":"6","author":"Davis","year":"2018","journal-title":"Microbiome"},{"key":"2026101911363841100_sjag215-B37","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1097\/PRS.0000000000009293","article-title":"How to report data on bilateral procedures and other issues with clustered data: the CLUDA reporting guidelines","volume":"150","author":"Hemmingsen","year":"2022","journal-title":"Plast Reconstr Surg"},{"key":"2026101911363841100_sjag215-B38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v015.i02","article-title":"The R package geepack for generalized estimating equations","volume":"15","author":"Halekoh","year":"2006","journal-title":"J Stat Softw"},{"key":"2026101911363841100_sjag215-B39","doi-asserted-by":"publisher","DOI":"10.1093\/asjof\/ojaf003","article-title":"Capsular contracture after breast augmentation: a systematic review and meta-analysis","volume":"7","author":"Haas","year":"2025","journal-title":"Aesthet Surg J Open Forum"},{"key":"2026101911363841100_sjag215-B40","doi-asserted-by":"publisher","first-page":"1986","DOI":"10.1016\/j.bjps.2019.09.010","article-title":"A comparative assessment of three planes of implant placement in breast augmentation: a Bayesian analysis","volume":"72","author":"Shen","year":"2019","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"2026101911363841100_sjag215-B41","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1097\/PRS.0000000000003575","article-title":"Macrotextured breast implants with defined steps to minimize bacterial contamination around the device: experience in 42,000 implants","volume":"140","author":"Adams","year":"2017","journal-title":"Plast Reconstr Surg"}],"container-title":["Aesthetic Surgery Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/asj\/advance-article-pdf\/doi\/10.1093\/asj\/sjag215\/71401088\/sjag215.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/asj\/advance-article-pdf\/doi\/10.1093\/asj\/sjag215\/71401088\/sjag215.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T15:36:42Z","timestamp":1792424202000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/asj\/advance-article\/doi\/10.1093\/asj\/sjag215\/8836466"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,26]]},"references-count":41,"URL":"https:\/\/doi.org\/10.1093\/asj\/sjag215","relation":{},"ISSN":["1090-820X","1527-330X"],"issn-type":[{"value":"1090-820X","type":"print"},{"value":"1527-330X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,26]]},"article-number":"sjag215"}}