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Open Biol. 2019 Apr 26;9(4):190006. doi: 10.1098/rsob.190006.

Is breast implant-associated anaplastic large cell lymphoma a hazard of breast implant surgery?

Fitzal F1, Turner SD2,3, Kenner L4,5,6,3,7.

Author information

1
1 Department of Surgery and Comprehensive Cancer Center, Medical University Vienna , Vienna , Austria.
2
2 Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge , Cambridge CB20QQ , UK.
3
6 Department for Experimental and Laboratory Animal Pathology, Clinical Institute of Pathology, Medical University of Vienna , 1090 Vienna , Austria.
4
3 Ludwig Boltzmann Institute for Cancer Research , 1090 Vienna , Austria.
5
4 Unit of Laboratory Animal Pathology, University of Veterinary Medicine Vienna , 1210 Vienna , Austria.
6
5 Division of Experimental Pathology, Medical University of Vienna , 1090 Vienna , Austria.
7
7 The European Research Initiative for ALK-related Malignancies (ERIA) , Cambridge , UK.

Abstract

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) may occur after reconstructive or aesthetic breast surgery. Worldwide, approximately 1.7 million breast implant surgeries are performed each year. To date, over 500 cases of BIA-ALCL have been reported around the world, with 16 women having died. This review highlights the most important facts surrounding BIA-ALCL. There is no consensus regarding the true incidence rate of BIA-ALCL as it varies between countries, is probably significantly under-reported and is difficult to estimate due to the true number of breast prostheses used largely being unknown. BIA-ALCL develops in the breast mostly as a seroma surrounding the implant, but contained within the fibrous capsule, or more rarely as a solid mass that can become invasive infiltrating the chest wall and muscle, in some instances spreading to adjacent lymph nodes, in these cases having a far worse prognosis. The causation of BIA-ALCL remains to be established, but it has been proposed that chronic infection and/or implant toxins may be involved. What is clear is that complete capsulectomy is required for treatment of BIA-ALCL, which for early-stage disease leads to cure, whereas chemotherapy is needed for advanced-stage disease, whereby improved results have been reported with the use of brentuximab. A worldwide database for BIA-ALCL and implants should be supported by local governments.

KEYWORDS:

anaplastic large cell lymphoma; breast implant-associated anaplastic large cell lymphoma; breast implants

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