Bacteriophage Therapy for Breast Implants: A Translational Perspective and Future Directions

Breast implant infection and capsular contracture remain significant complications of implant-based breast surgery, largely driven by bacterial biofilm formation. Despite adherence to perioperative antibiotic prophylaxis and pocket irrigation protocols, established biofilms are difficult to eradicate and frequently necessitate implant removal, resulting in reconstructive, psychological, and financial consequences for patients. In the context of rising antimicrobial resistance and the limited efficacy of antibiotics against biofilm-associated bacteria, bacteriophage therapy has emerged as a biologically compelling adjunctive strategy. Bacteriophages are viruses that selectively infect and lyse bacteria, with a demonstrated capacity to penetrate biofilms and disrupt structured microbial communities. Encouraging clinical outcomes have been reported in orthopedic prosthetic joint infections and vascular graft infections, where phage therapy, often combined with antibiotics, has achieved high rates of bacterial eradication and implant salvage. However, its application in implant-based breast surgery remains largely unexplored, with evidence currently limited to a single experimental study. This translational perspective reviews the biological rationale for bacteriophage use in breast implant-associated biofilm, examines parallels from other implant specialties, and outlines potential preventive and therapeutic applications within breast surgery. Key barriers, including regulatory challenges, phage specificity, delivery strategies within the implant pocket, immune considerations, and the potential emergence of phage resistance, are critically discussed. Bridging this translational gap will require implant-specific biofilm models, standardized delivery protocols, and early-phase clinical evaluation. Bacteriophage therapy represents a promising yet underdeveloped strategy that may expand future options for implant infection management and salvage and, potentially, capsular contracture prevention.