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Meta-Analysis
. 2024 Dec;48(24):5315-5328.
doi: 10.1007/s00266-024-03956-9. Epub 2024 May 9.

The Risk of Breast Implant-Associated Anaplastic Large Cell Lymphoma; A Systematic Review and Meta-Analysis

Ali Mohamed Elameen  1 , Mohamed Awad AlMarakby  2 , Tarek Ibrahim Atta  3 , Asmaa Ali Dahy  4
Affiliations
Meta-Analysis

The Risk of Breast Implant-Associated Anaplastic Large Cell Lymphoma; A Systematic Review and Meta-Analysis

Ali Mohamed Elameen et al. Aesthetic Plast Surg. 2024 Dec.

Abstract

Background: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an emerging disorder that has gained global attention throughout the past era. The present meta-analysis was performed to retrieve the risk of BIA-ALCL from population-based epidemiological studies. Factors associated with BIA-ALCL were evaluated to identify patients at higher risk of BIA-ALCL.

Methods: A systematic literature search was executed throughout 12 databases. All epidemiological studies encompassing patients with breast implants either for aesthetic or reconstructive purposes and reported the risk of BIA-ALCL were included. Studies reported the risk factors of BIA-ALCL were included.

Results: The present meta-analysis included 17 articles, encompassing 525,475 patients with breast implants. There were 254 patients with BIA-ALCL with a mean duration to the diagnosis of BIA-ALCL of 13.16 years (95% CI 11.7-14.6, P < 0.001). There were 44 patients with textured breast implants and two with smooth implants. Patients with breast implants were 28.86 times more at high risk of BI-ALCL (95% CI 3.123-266.681). The risk ranged from 0 to 1 per 1000 cases with breast implants, with a similar risk among patients seeking aesthetic and reconstructive surgeries. The risk was 0 to 1 case per 1000 cases among patients with textured breast implants. There was a significant association between the history of breast cancer and BIA-ALCL (P = 0.0016).

Conclusion: This meta-analysis confirmed the association between breast implants and ALCL. There was a similar risk of BIA-ALCL among patients with aesthetic or reconstructive surgeries. Patients with a history of breast cancer were at higher risk of BIA-ALCL.

Level of evidence iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Anaplastic large cell lymphoma; BIA-ALCL; Breast implants.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no conflicts of interest to disclose. Informed Consent: For this type of study, informed consent is not required. Human and Animal Rights: This article does not contain any studies with human participants or animals performed by any of the authors.

Figures

Fig. 1
Fig. 1
PRISMA 2020 flow diagram for updated systematic reviews which included searches of databases, registers, other sources, and screening
Fig. 2
Fig. 2
Forest plot of summary analysis of the (A) Event rate and 95% CI of the prevalence of BIA-ALCL among patients with breast implants. (B) Funnel plots showing evidence of publication bias on the left side and after imputing the studies on the right side. (C) Subgroup analysis of the event rate and 95% CI of the prevalence of BIA-ALCL among patients with breast implants based on the regions of the included studies. (D) Cumulative incidence of BIA-ALCL per 1000 patients per year among patients with breast implants. The size of the black squares is proportional to the statistical weight of each trial. The black diamond represents the pooled point estimate. The positioning of both diamonds and squares (along with 95% CIs) beyond the vertical line (unit value) suggests a significant outcome
Fig. 3
Fig. 3
Forest plot of summary analysis of the (A) Event rate and 95% CI of the prevalence of BIA-ALCL among patients seeking breast implants for aesthetic purposes. (B) Event rate and 95% CI of the prevalence of BIA-ALCL among patients seeking breast implants for reconstructive purposes. (C) Event rate and 95% CI of the prevalence of BIA-ALCL among patients with textured breast implants. (D) Event rate and 95% CI of the prevalence of BIAALCL among patients with smooth breast implants. The size of the black squares is proportional to the statistical weight of each trial. The black diamond represents the pooled point estimate. The positioning of both diamonds and squares (along with 95% CIs) beyond the vertical line (unit value) suggests a significant outcome
Fig. 4
Fig. 4
Forest plot of summary analysis of the (A) Event rate and 95% CI of the prevalence of BIA-ALCL among patients with silicone breast implants. (B) Odds ratio (OR) and 95% CI of the association between breast implants and ALCL. (C) Odds ratio (OR) and 95% CI of the association between polyurethane breast implants and ALCL. (D) Odds ratio (OR) and 95% CI of the association between biocell textured breast implants and ALCL. (E) Weighted random-effects meta regression analysis regressing risk of BIA-ALCL against the follow-up period. (F) Weighted random-effects meta regression analysis regressing risk of BIA-ALCL against the history of breast cancer. The size of the black squares is proportional to the statistical weight of each trial. The black diamond represents the pooled point estimate. The positioning of both diamonds and squares (along with 95% CIs) beyond the vertical line (unit value) suggests a significant outcome
See this image and copyright information in PMC

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