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Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) and the Textured Breast Implant Crisis

  • Anne K GrothEmail author
  • Ruth Graf
Original Article Breast Surgery

Abstract

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon T-cell, CD-30+/ALK lymphoma. Late (9 years) periprosthetic fluid (seroma) is the most common presentation (90% of the cases). A combination of textured breast implant, bacterial contamination, and genetic predisposition seems to be necessary for BIA-ALCL to occur. There are 35 million patients with implants in the world, and at the present moment, 573 cases of BIA-ALCL have been reported. The risk of developing BIA-ALCL in Australia varies from 1:2832 to 1:86,029, with texture grades 3 and 4 seeming to pose a higher risk than grades 2 and 1. NCCN has established guidelines for diagnosis and treatment, and early diagnosis is the key to cure. At an early stage and for the vast majority of patients, the treatment consists of capsulectomy and implant removal. However, at stages II to IV, a systemic treatment is warranted, including chemotherapy, radiotherapy (residual disease), and brentuximab vedotin. The majority of patients can be cured, and complete capsular removal is the most important factor. So far, 33 patients have died from BIA-ALCL worldwide, with deaths related to delay in diagnosis and treatment. Textured implants have been in the midst of the current implant crisis, and Biocell was recalled worldwide after the latest FDA update on the disease. At the present moment, no medical society or regulatory agency has recommended implant removal. It is about time that we start robust breast implant registries to determine risks. Besides, based on scientific criteria, we must consider all the benefits and risks associated with the available breast devices.

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

Breast implants Silicone elastomers Lymphoma, large cell, anaplastic: breast 

Notes

Compliance with Ethical Standards

Conflict of interest

Dr. Groth has received a speaker honorarium from Allergan. The authors received no financial support for the research, authorship, and publication of this article.

Human and Animal Rights

This article did not require any studies with human participants or animals performed by any of the authors.

Informed Consent

Informed consent is not required for this type of study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  1. 1.Brazilian Society of Plastic SurgeryCuritibaBrazil
  2. 2.Plastic Surgery and Microsurgery DepartmentErasto Gaertner HospitalCuritibaBrazil
  3. 3.Positivo University Medical SchoolCuritibaBrazil
  4. 4.CuritibaBrazil
  5. 5.Federal University of ParanaCuritibaBrazil
  6. 6.Pieta Medical CenterCuritibaBrazil

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