Breast Implant–AssociatedAnaplastic Large Cell Lymphoma: Proposal for a Monitoring Protocol
Plastic &
Reconstructive Surgery: August 2015 - Volume 136 - Issue 2 - p 144e–151e
Background: The authors
report four cases of breast implant–associated anaplastic large cell lymphoma
(ALCL) from a single institution and propose a multidisciplinary protocol.
Methods: From 2012 to 2014, four breast implant–associated ALCL cases were diagnosed.
The authors performed the original operation, and no patients were referred to
their practice. Cases 1, 2, and 4 were CD4+/CD30+/ALK− ALCL with previous
textured-implant reconstruction, whereas case 3 was CD8+/CD30+/ALK− ALCL with
previous polyurethane-implant augmentation. A retrospective study of all
patients who underwent breast implant positioning was performed to identify any
misdiagnosed cases. Results: Of 483 patients, 226 underwent reconstruction with
latissimus dorsi flap and prosthesis, 115 had skin-sparing/nipple-sparing
mastectomy and prosthesis, 117 underwent an expander/implant procedure, and 25
underwent breast augmentation. Fifty-eight cases (12 percent) underwent implant
replacement for capsular contracture, 15 (3.1 percent) experienced late-onset
seroma, and four (0.83 percent) had both capsular contracture and seroma.
Seventy-seven symptomatic patients (16 percent) underwent surgical revision
(capsulectomy/capsulotomy) and/or seroma evacuation. The second look on
histologic specimens did not identify misdiagnosed cases. A multidisciplinary
protocol for suspected implant-associated ALCL was established. Ultrasound and
cytologic examinations are performed in case of periprosthetic effusion. If
implant-associated ALCL is diagnosed, implant removal with capsulectomy is
performed. If disseminated disease is detected through positron emission
tomography/computed tomography of the total body, the patient is referred to
the oncology department. Conclusions: A multidisciplinary protocol is mandatory
for both early diagnosis and patient management. Until definitive data emerge
regarding the exact etiopathogenesis of breast implant–associated ALCL, the
authors suggest offering only autologous reconstruction if patients desire it.
