Breast Implants and Anaplastic Large Cell Lymphoma (ALCL). Only recently described, breast implant–associated ALCL (BIA-ALCL) usually presents as an effusion-associated fibrous capsule surrounding the implant and less frequently as a mass. To the best of my knowledge, this is the first video to demonstrate the unexpected diagnosis of BIA-ALCL.
Little is known about the natural history and long-term outcomes of such a disease. What we do know so far is that BIA-ALCL occurs at a mean of 8 years post implantation and is most commonly a T-cell lymphoma, is CD30 receptor protein positive and does not have an anaplastic lymphoma kinase gene translocation (ALK -). The exact cause of BIA-ALCL is still unknown and not possible to determine if it’s specific to any manufacturer or breast implant type. What we do know is that it may involve a combination of genetic predisposition, biofilm and textured implants
Current recommendations for the diagnosis, treatment and monitoring of BIA-ALCL include:
- Any patient presenting with late peri-implant seroma (>1 year), consider U/S (if inconclusive do PET CT or MRI) to rule out effusion, mass +/- lymph nodes and send seroma for culture, flow cytometry and cell block. Note 1 in 8 cases present with lymphadenopathy. There is no role for mammography.
- Send tissue samples for CD30 and ALK to haematologist experienced with ALCL.
- Confirmed localized BIA-ALCL requires explantation and total capsulectomy (surgical oncologist recommended). Consider removal contralateral breast implant as several bilateral cases detected incidentally. Monitoring by oncologist for surveillance every 6 months for 5 years with annual U/S +/- PET CT for 2 years. Advanced disease requires surgery (mass, lymph nodes), chemotherapy (CHOP: cyclophosphamide, doxorubicin, vincristine, prednisolone), targeted immunotherapy (Brentuximab vedotin) and chest wall radiation for unresectable tumours or positive margins. BIA-ALCL has a more favourable prognosis than systemic forms of ALCL. BIA-ALCL with mass has higher but significant disease recurrence and progression.
- Reconstruction suggested >1 year surveillance. Replacement with smooth implants has been performed without reported progression or recurrence of disease but ongoing safety of this strategy is still being investigated. Autologous reconstruction favoured when possible.
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