Plastic Surgery Research Council

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A Systematic Review of Breast-Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): Past and Current Knowledge
Hassan ElHawary, M.Sc1, Nebras Ghazawi1, Johnny Efanov, M.D2, Ali Izadpanah, M.D.2.
1McGill University, Montreal, QC, Canada, 2University of Montreal Health Centre, Montreal, QC, Canada.

Purpose:
The rise in alloplastic breast reconstruction has revealed a rare but serious associated malignancy, breast-implant associated anaplastic large cell lymphoma (BIA-ALCL). The first case of BIA-ALCL was diagnosed in 1997, but due to the novelty and low prevalence of this condition, many unknown characteristics remain. The aim of this study was to systematically review the literature on BIA-ALCL and to reveal certain patterns in terms of patient demographics, presenting symptoms, geographical distribution, associated biological markers, and treatment options.
Methods:
PubMed, Google scholar and EBSCOhost were searched to find all publications pertaining to BIA-ALCL. The terms "Breast Implant" and "Anaplastic Large Cell Lymphoma" were used as keywords and ‘exploded' to include articles indexed with these headings as well as those indexed with any related terms. Inclusion criteria consisted of case reports or case series that describe BIA-ALCL. Articles published in English or French, commentaries or discussions, and studies on systemic ALCL were excluded. The data extracted included patient age, time of onset, diagnosis, pathophysiology, implant type, implant manufacturer, and treatment options.
Results:
Out of the 79 BIA-ALCL cases reported in the literature, 23 cases were saline filled implants and 47 were silicone filled. In the remaining cases, the type was unidentified. The mean age at diagnosis was 51.35 ±12.47 and 52.15 ±12.28 for patients with saline and silicone implants respectively (p>0.05). The time of onset after surgery was 10.83 ±6.72 years and 12.04 ±5.04 year for saline and silicone filled implant, respectively (p>0.05). The most common indication for surgery for both saline and silicone implant was cosmetic (44.30%) followed by oncotic breast reconstruction (39.24%). The most common initial presentation was seroma (26.5%) followed by swelling (24.1%), breast pain (22.7%) and palpated mass (21.5%). The most common surface type associated with BIA-ALCL was textured implants. Furthermore, 61 cases reported an Anaplastic Lymphoma Kinase Negative (ALK-) enzyme while 55 cases reported a CD30+ antigen. The main treatment options for ALCL were chemotherapy in conjunction with radiation therapy (25.31%), capsulotomy (15.18%) or chemotherapy alone (8%) (Table 1). Although only 79 cases were included in this review, there are many more cases that aren't scientifically published. Many cases are briefly reported by government bodies and plastic surgery associations without providing sufficient information to be useful to analyze in this review. For example, the department of health in Australia reported 72 cases of BIA-ALCL without providing specific details about them. While these cases aren't analyzed in this abstract they will be included in the presentation for a more accurate depiction of prevalence rates.
Conclusion:
BIA-ALCL is a relatively new and rare condition that is not fully understood. This study reviews all the published BIA-ALCL cases and describes different characteristics associated with this condition. While further understanding of BIA-ALCL continues to be pursued, this review will aid in disseminating more information about this medical entity.

Treatments of BIA-ALCL
TreatmentNumber of cases
Chemotherapy + radiotherapy20
Capsulectomy14
Chemotherapy7
Mastectomy6
Capsulectomy + Radiotherapy6
Radiotherapy1
Unknown31


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