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Foppiani JA, Raska O, Taritsa I, Hernandez Alvarez A, Lee D, Escobar-Domingo MJ, Berger J, Klener P, Schuster KA, Abdo D, Clemens MW, Lin SJ. Incidental Bystander or Essential Culprit: A Systematic Review of Bacterial Significance in the Pathogenesis of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Int J Mol Sci 2023; 25:355. [PMID: 38203524 PMCID: PMC10778958 DOI: 10.3390/ijms25010355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a distinct subtype of T-cell non-Hodgkin lymphoma that arises in the context of prolonged exposure to textured breast implants. The intent of this manuscript is to explore whether the bacterial presence in biofilms on these implants is a mere incidental finding or plays a pivotal role in the pathogenesis of BIA-ALCL. Our goal is to delineate the extent of bacterial involvement, offering insights into potential underlying mechanisms, and establishing future research priorities aimed at resolving the remaining uncertainties surrounding this complex association. A comprehensive systematic review of several databases was performed. The search strategy was designed and conducted by an experienced librarian using controlled vocabulary with keywords. The electronic search identified 442 publications. After evaluation, six studies from 2015 to 2021 were included, encompassing 201 female patients aged 23 to 75. The diagnosis span post-implantation ranged from 53 to 135.6 months. Studies consistently found bacteria near breast implants in both BIA-ALCL cases and controls, with varied microbial findings. Both BIA-ALCL cases and controls exhibited the presence of specific bacteria, including Pseudomonas aeruginosa, Klebsiella oxytoca, Staphylococcus aureus, and Ralstonia spp., without any statistically significant differences between groups. The use of antiseptic and antimicrobial agents during implant insertion did not demonstrate any impact on reducing or altering the risk of developing BIA-ALCL. Our systematic review reveals that the current evidence is inadequate to link bacterial etiology as a central factor in the development of BIA-ALCL. The limitations in the existing data prevent a complete dismissal of the role of biofilms in its pathogenesis. The observed gap in knowledge underscores the need for more focused and comprehensive research, which should be structured in a multi-faceted approach. Initially, this involves the utilization of sophisticated genomic and proteomic methods. Following this, it is crucial to delve into the study of immunological reactions specifically induced by biofilms. Finally, this research should incorporate extended observational studies, meticulously tracking the evolution of biofilm development and its correlation with the emergence of BIA-ALCL. In light of the inconclusive nature of current findings, further investigation is not only justified but urgently needed to clarify these unresolved issues.
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Affiliation(s)
- Jose A. Foppiani
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (I.T.); (A.H.A.); (D.L.); (M.J.E.-D.); (K.A.S.); (S.J.L.)
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, 12108 Prague, Czech Republic
| | - Otakar Raska
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, 12108 Prague, Czech Republic
| | - Iulianna Taritsa
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (I.T.); (A.H.A.); (D.L.); (M.J.E.-D.); (K.A.S.); (S.J.L.)
| | - Angelica Hernandez Alvarez
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (I.T.); (A.H.A.); (D.L.); (M.J.E.-D.); (K.A.S.); (S.J.L.)
| | - Daniela Lee
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (I.T.); (A.H.A.); (D.L.); (M.J.E.-D.); (K.A.S.); (S.J.L.)
| | - Maria J. Escobar-Domingo
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (I.T.); (A.H.A.); (D.L.); (M.J.E.-D.); (K.A.S.); (S.J.L.)
| | | | - Pavel Klener
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, 12108 Prague, Czech Republic
- First Department of Internal Medicine, Department of Hematology, First Faculty of Medicine Charles University, General University Hospital, 12808 Prague, Czech Republic
| | - Kirsten A. Schuster
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (I.T.); (A.H.A.); (D.L.); (M.J.E.-D.); (K.A.S.); (S.J.L.)
| | - Daoud Abdo
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, 12108 Prague, Czech Republic
| | - Mark W. Clemens
- MD Anderson Cancer Center, The University of Texas, Houston, TX 77030, USA;
| | - Samuel J. Lin
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (I.T.); (A.H.A.); (D.L.); (M.J.E.-D.); (K.A.S.); (S.J.L.)
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McGuire PA, Glicksman C, McCarthy C, Spiegel A. Separating Myth from Reality in Breast Implants: An Overview of 30 Years of Experience. Plast Reconstr Surg 2023; 152:801e-807e. [PMID: 37010472 DOI: 10.1097/prs.0000000000010488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
SUMMARY The purpose of this article is to review the pivotal events in the history of breast implants in the United States, including the events leading to the U.S. Food and Drug Administration moratorium on the use of silicone gel implants and subsequent approval; the emergence of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL); and persistent concerns about an association between breast implants, autoimmune disease, and systemic symptoms. This article reviews the medical literature to outline our current knowledge on BIA-ALCL; offers recommendations for diagnosis and management of symptomatic and asymptomatic patients with textured implants; and reviews the science of potential associations of implants with autoimmune and systemic symptoms. The authors hope to help patients separate myths from reality and make educated decisions on having breast implants placed or removed.
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Affiliation(s)
| | | | - Colleen McCarthy
- the Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Aldona Spiegel
- The Center for Breast Restoration, Weill Cornell Medical School, Houston Methodist Academic Institute, and Division of Surgical Innovation, Houston Methodist Hospital
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A Spectrum of Disease: Breast Implant-Associated Anaplastic Large Cell Lymphoma, Atypicals, and Other Implant Associations. Clin Plast Surg 2023; 50:249-257. [PMID: 36813403 DOI: 10.1016/j.cps.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon and emerging malignancy caused by textured breast implants. The most common patient presentation is delayed seromas, other presentations include breast asymmetry, overlying skin rashes, palpable masses, lymphadenopathy, and capsular contracture. Confirmed diagnoses should receive lymphoma oncology consultation, multidisciplinary evaluation, and PET-CT or CT scan evaluation prior to surgical treatment. Disease confined to the capsule is curable in the majority of patients with complete surgical resection. BIA-ALCL is now recognized as one disease among a spectrum of inflammatory mediated malignancies which include implant-associated squamous cell carcinoma and B cell lymphoma.
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Ha HJ, Jeong SH, Yang JY, Kim CW, Hwang E. Prevention of Breast Implant Displacement Using the Acellular Dermal Matrix Garter Belt. Aesthetic Plast Surg 2021; 46:1042-1049. [PMID: 34845513 DOI: 10.1007/s00266-021-02665-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Since the issue of breast implant-associated anaplastic large cell lymphoma, smooth breast implants tend to be the more preferred option in implant-based breast reconstructions, compared to its use previously. The most unfavorable aspect of smooth implants is lateral and inferior displacements, which are more common in patients who undergo breast reconstruction compared to augmentation mammoplasty. Hence, we introduce a prevention method for implant displacement using an acellular dermal matrix garter belt. METHODS This study is a retrospective review of patients who had undergone implant-based breast reconstruction between April 2019 and December 2020. Some patients who have highly possibility of implant displacement, had undergone the application of an ADM garter belt to prevent lateral or superior displacement. Implant displacement was assessed before and at least 6 months postoperatively. RESULTS A total of 155 IBR cases were recorded. ADM garter belts were applied in 27 patients (17.4%) who had a high tendency of implant displacement for several reasons, which could be classified into two categories: wide breast pocket (56%) and tight inferomedial breast pocket (44%). The intraoperative average distance of lateral slipping on patients' reconstructed breasts from the chest wall midline in supine position was 3.02 ± 0.81 cm and corrected to1.54 ± 0.69 cm at least 6 months postoperative follow-up. CONCLUSIONS We utilized an ADM strap as an internalized garter belt to minimize implant displacement. This ADM garter belt combined with capsuloplasty might be an effective way to prevent the displacement of smooth implants in the patients with a greater risk of implant displacement. LEVEL OF EVIDENCE IV 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.
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Van Natta BW. Letter to the editor regarding jewell letter to the editor regarding: Risk of breast implant associated anaplastic large cell lymphoma in a cohort of 3546 women prospectively followed long term after reconstruction with macro-textured breast implants. J Plast Reconstr Aesthet Surg 2020:S1748-6815(20)30620-3. [PMID: 33279432 DOI: 10.1016/j.bjps.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/12/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Bruce W Van Natta
- Meridian Plastic Surgeons, Indianapolis IN USA; Indiana University Division of Plastic Surgery, Indianapolis IN USA.
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