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Review
. 2019 Nov;33(4):270-278.
doi: 10.1055/s-0039-1696998. Epub 2019 Oct 17.

Finding Consensus After Two Decades of Breast Implant-Associated Anaplastic Large Cell Lymphoma

Mark W Clemens  1 , Ryan C DeCoster  2   3 , Berry Fairchild  4 , Alexander A Bessonov  5 , Fabio Santanelli di Pompeo  6
Affiliations
Review

Finding Consensus After Two Decades of Breast Implant-Associated Anaplastic Large Cell Lymphoma

Mark W Clemens et al. Semin Plast Surg. 2019 Nov.

Abstract

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an emerging and indolent, but potentially fatal cancer of the immune system that can develop around textured-surface breast implants. The World Health Organization first recognized BIA-ALCL as a unique clinical entity in 2016. To date, over 600 confirmed cases have been reported worldwide. BIA-ALCL most commonly presents with disease confined to the capsule, as a seroma or a mass adjacent to the implant. While BIA-ALCL has a fairly indolent clinical course, with an excellent prognosis in early stage disease, disseminated cancer and death have also been reported. In this review, the authors focus on the early diagnosis and treatment, including reconstructing the breast following BIA-ALCL, and also discuss recently updated National Comprehensive Cancer Network guidelines. They also review the current epidemiology and risk factors associated with BIA-ALCL. Finally, they discuss important medicolegal considerations and the bioethics surrounding the continued use of textured-surface breast implants.

Keywords: CD30; anaplastic large cell lymphoma; and Late Seroma; breast implant-associated ALCL; double capsule; non-Hodgkin lymphoma.

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Conflict of interest statement

Conflicts of Interest None of the authors have associations or financial disclosures to report that create a conflict of interest with the information presented in this article. Dr. Clemens is a clinical investigator for Motiva US Safety Trial (Establishment Labs) and was a former Allergan consultant (2012–2015).

Figures

Fig. 1
Fig. 1
BIA-ALCL Disease Algorithm. Current evidence-based algorithm for achieving diagnosis, followed by treatment based on stage of disease. (Reprinted with permission from Clemens MW, Jacobsen ED, Horwitz SM. 2019 NCCN Consensus Guidelines on the Diagnosis and Treatment of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). Aesthet Surg J. 39(S1) S3–S13, 2019.)
Fig. 2
Fig. 2
Smooth and a textured surface breast implant. To date, all known cases of BIA-ALCL worldwide with a known clinical history have involved a prior textured device. Therefore, a textured surface implant may be integral to the pathogenesis of BIA-ALCL.
Fig. 3
Fig. 3
A malignant effusion in a BIA-ALCL patient demonstrates large pleomorphic anaplastic cells with prominent horseshoe-shaped nuclei and nuclear folding. (hematoxylin stain, 500X magnification) Positive anaplastic cytology, CD30 immunohistochemistry expression, and single T cell clonality demonstrated on flow cytometry are required for BIA-ALCL diagnosis.
Fig. 4
Fig. 4
The treatment of BIA-ALCL is demonstrated with explantation of the device and total capsulectomy. The patient had a previous history of breast cancer which was treated with a mastectomy and prosthetic reconstruction. Following diagnosis of BIA-ALCL, the patient was not interested in further reconstruction and therefore a ellipse of skin was resected with the capsule for contouring of the chest skin.
Fig. 5
Fig. 5
The capsule and implant of a BIA-ALCL patient are shown during evaluation by pathology. Note the thickened surface of the capsule which had developed into a mass.
See this image and copyright information in PMC

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