Breast implant surface texture is associated with distinct implant microbiome profiles in humans

Surface topography of silicone breast implants modulates foreign body responses, but its connection to implant-associated microbial communities remains unclear. We analyzed the microbiome of 391 explanted breast implants from 221 patients with different surface textures using 16S rRNA gene sequencing. We found that the surface texture is associated with distinct microbial communities depending on a surface roughness gradient. Rougher surfaces had lower microbial diversity, driven by lower evenness and a higher relative abundance of Staphylococcus than smoother surfaces. Compositional differences across surface groups followed this gradient. In a subset of samples, absolute bacterial quantification using digital PCR showed increasing total bacterial burden with increasing surface roughness. Smooth and minimally textured implants displayed similar microbiome profiles despite large differences in implantation time. Together, these findings suggest that surface roughness is associated with the local microbial microenvironment, linking material design with microbial burden and the foreign body response. STATEMENT OF SIGNIFICANCE: Breast implant surface topography may influence implant-associated microbial communities, but human evidence across commonly used textures is limited. Using 16S rRNA gene sequencing of 391 explanted implants from multiple manufacturers, we found that microbial diversity and composition varied systematically with a surface roughness gradient. Rougher textures showed lower diversity driven by reduced evenness and a higher relative abundance of Staphylococcus, while compositional differences across surface groups followed the same gradient. Quantitative digital PCR further suggested a higher total bacterial burden on rougher surfaces. In contrast, smooth and minimally textured implants displayed similar microbiome profiles despite large differences in implantation time. These findings link implant surface design to microbial ecology and may help explain texture-associated differences in foreign body responses.