1
|
Swanson E. BIA-ALCL: Comparing the Risk Profiles of Smooth and Textured Breast Implants. Aesthetic Plast Surg 2023; 47:245-250. [PMID: 36997735 PMCID: PMC10439047 DOI: 10.1007/s00266-023-03329-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/19/2023] [Indexed: 04/01/2023]
Affiliation(s)
- Eric Swanson
- Swanson Center, 11413 Ash St, Leawood, KS, 66211, USA.
| |
Collapse
|
2
|
Zaussinger M, Duscher D, Huemer GM. Nagor Impleo Round Silicone Gel Breast Implants: Early Outcome Analysis after 340 Primary Breast Augmentations. J Clin Med 2023; 12:jcm12113708. [PMID: 37297902 DOI: 10.3390/jcm12113708] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/20/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
For decades, implant-based breast augmentation has been one of the most performed surgical procedures for cosmetic purposes around the world. Hence, novel manufactured implants should be critically investigated to prove them safe and effective. Here, the authors describe the first independently conducted clinical study on Nagor Impleo textured round breast implants. For this retrospective study, outcomes of 340 consecutive female patients undergoing primary cosmetic breast augmentation were analyzed. Demographic and surgical data as well as outcomes and complications were evaluated. Furthermore, a survey concerning effectiveness and aesthetic satisfaction after breast augmentation was examined. All 680 implants were placed in a submuscular plane with incisions at the inframammary fold. The main indications for surgery were hypoplasia and hypoplasia with asymmetry. The mean implant volume was 390 cc and the main type of projection was high profile. The most common complications were hematoma and capsular contracture (0.9 percent, respectively). The overall revision rate for complications was 2.4%. Additionally, almost all patients showed increased quality of life and aesthetic satisfaction after a breast augmentation. Hence, all patients would undergo breast augmentation again with these newly launched devices. Nagor Impleo implants demonstrate a low complication rate and high safety profile. Although high aesthetic satisfaction and quality of life results were achieved, analysis of an even larger series over a longer period of time would be beneficial to evaluate the reliability of this implant.
Collapse
Affiliation(s)
- Maximilian Zaussinger
- Medical Faculty, Johannes Kepler University Linz, Altenbergerstr. 69, 4040 Linz, Austria
- Section of Plastic, Aesthetic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
| | - Dominik Duscher
- Department of Plastic, Reconstructive, Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
| | - Georg M Huemer
- Medical Faculty, Johannes Kepler University Linz, Altenbergerstr. 69, 4040 Linz, Austria
- Section of Plastic, Aesthetic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
| |
Collapse
|
3
|
Mankowski P, Carr M, Cherukupalli A, Bovill E, Lennox P, Brown MH, Carr N. The Macrotextured Implant Recall: Breast Implant-Associated-Anaplastic Large Cell Lymphoma Risk Aversion in Cosmetic and Reconstructive Plastic Surgery Practices. Aesthet Surg J 2022; 42:1408-1413. [PMID: 35709374 DOI: 10.1093/asj/sjac158] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The recall of Allergan Biocell (Irvine, CA) devices due to the association between anaplastic large cell lymphoma (ALCL) and macrotextured breast implants means that plastic surgeons are faced with the challenge of caring for patients with these implants in situ. Cosmetic and reconstructive surgeons have been contacting affected patients to encourage them to follow up and discuss the most appropriate risk-reduction strategies. OBJECTIVES The aim of this study was to evaluate patient concerns about the risk of breast implant-associated ALCL (BIA-ALCL) and to compare management differences between cosmetic and reconstructive patients. METHODS A retrospective review was performed of 432 patients with macrotextured implants who presented to clinic after being contacted (121 reconstructive and 311 cosmetic). These records were analyzed for their presenting concerns, surgery wait times, and management plans. Statistical analysis was performed to compare the cohorts, and odds ratios (ORs) were computed to determine the association between patient concerns and their choice of management. RESULTS After consultation, 59.5% of the reconstructive cohort and 49.5% of the cosmetic cohort scheduled implant removal or exchange. The reconstructive population had a higher rate of ALCL concern (62.7%); however, both cohorts had a significant OR, demonstrating an expressed fear of ALCL likely contributed to their subsequent clinical management (OR cosmetic, 1.66; OR reconstructive, 2.17). CONCLUSIONS Although the risk of ALCL appears to be more concerning to the reconstructive population, both cohorts were equally motivated to have their implants removed. Informing patients about their ALCL risk is crucial to ensure a patient-supported risk reduction plan. LEVEL OF EVIDENCE: 2
Collapse
Affiliation(s)
- Peter Mankowski
- University of British Columbia Department of Surgery, Division of Plastic Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| | - Matthew Carr
- University of British Columbia Department of Surgery, Division of Plastic Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| | - Abhiram Cherukupalli
- University of British Columbia Department of Surgery, Division of Plastic Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| | - Esta Bovill
- University of British Columbia Department of Surgery, Division of Plastic Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| | - Peter Lennox
- University of British Columbia Department of Surgery, Division of Plastic Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| | - Mitchell H Brown
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Carr
- University of British Columbia Department of Surgery, Division of Plastic Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| |
Collapse
|
4
|
Naga HI, Mellia JA, Basta MN, Morris MP, Christopher AN, Campbell FM, Sommers K, Levinson H, Nelson JA, Fischer JP. Breast Implant-Associated Anaplastic Large-Cell Lymphoma: Updated Systematic Review and Analysis of Treatment Strategies. Plast Reconstr Surg 2022; 150:762-769. [PMID: 35862104 PMCID: PMC9551598 DOI: 10.1097/prs.0000000000009538] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although guidelines have been published on treatment of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL), there has been no comprehensive analysis of BIA-ALCL treatment variation based on the available literature. The authors sought to assess current treatment strategies of BIA-ALCL relative to current guidelines. METHODS Database searches were conducted in June of 2020. Included articles were case reports and case series with patient-level data. Collected variables included clinicopathologic features, implant characteristics, diagnostic tests, ALCL characteristics, treatment, and details of follow-up and outcome. Treatment data from before and after 2017 were compared with National Cancer Center Network guidelines. RESULTS A total of 89 publications were included and 178 cases of BIA-ALCL were identified. Most patients presented with seroma ( n = 114, 70.4 percent), followed by a mass ( n = 14, 8.6 percent), or both ( n = 23, 14.2 percent). Treatment included en bloc capsulectomy of the affected implant in 122 out of 126 cases with treatment details provided (96.8 percent). Radiation therapy was given in 38 cases (30.2 percent) and chemotherapy was given in 71 cases (56.3 percent). Practitioners used less chemotherapy for local disease after treatment guideline publication in 2017 ( p < 0.001), whereas treatment for advanced disease remained unchanged ( p = 0.3). There were 10 recurrences and eight fatalities attributable to BIA-ALCL, which were associated with advanced presentation (29 versus 2.1 percent; OR, 19.4; 95 percent CI, 3.9 to 96.3; p < 0.001). CONCLUSIONS BIA-ALCL remains a morbid but treatable condition. Current guidelines focus treatment for local disease and reduce nonsurgical interventions with radiation or chemotherapy. Patients presenting with advanced BIA-ALCL experience higher rates of recurrence and mortality.
Collapse
Affiliation(s)
- Hani I. Naga
- Division of Plastic Surgery, Duke University, Durham, NC
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Joseph A. Mellia
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Marten N. Basta
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Martin P. Morris
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | | | - Frank M. Campbell
- Biomedical Library, Perelman School of Medicine, University of Pennsylvania, PA
| | | | - Howard Levinson
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
- Plastic Surgery Foundation, Arlington Heights, IL
| | - Jonas A. Nelson
- Plastic and Reconstructive Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - John P. Fischer
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
5
|
Santanelli di Pompeo F, Clemens MW, Atlan M, Botti G, Cordeiro PG, De Jong D, Di Napoli A, Hammond D, Haymaker CL, Horwitz SM, Hunt K, Lennox P, Mallucci P, Miranda RN, Munhoz AM, Swanson E, Turner SD, Firmani G, Sorotos M. 2022 Practice Recommendation Updates From the World Consensus Conference on BIA-ALCL. Aesthet Surg J 2022; 42:1262-1278. [PMID: 35639805 PMCID: PMC9924046 DOI: 10.1093/asj/sjac133] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Laboratory and clinical research on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is rapidly evolving. Changes in standard of care and insights into best practice were recently presented at the 3rd World Consensus Conference on BIA-ALCL. OBJECTIVES The authors sought to provide practice recommendations from a consensus of experts, supplemented with a literature review regarding epidemiology, etiology, pathogenesis, diagnosis, treatment, socio-psychological aspects, and international authority guidance. METHODS A literature search of all manuscripts between 1997 and August 2021 for the above areas of BIA-ALCL was conducted with the PubMed database. Manuscripts in different languages, on non-human subjects, and/or discussing conditions separate from BIA-ALCL were excluded. The study was conducted employing the Delphi process, gathering 18 experts panelists and utilizing email-based questionnaires to record the level of agreement with each statement by applying a 5-point Likert Scale. Median response, interquartile range, and comments were employed to accept, reject, or revise each statement. RESULTS The literature search initially yielded 764 manuscripts, of which 405 were discarded. From the remaining 359, only 218 were included in the review and utilized to prepare 36 statements subdivided into 5 sections. After 1 round, panelists agreed on all criteria. CONCLUSIONS BIA-ALCL is uncommon and still largely underreported. Mandatory implant registries and actions by regulatory authorities are needed to better understand disease epidemiology and address initial lymphomagenesis and progression. Deviation from current diagnosis and treatment protocols can lead to disease recurrence, and research on breast implant risk factors provide insight to etiology. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- Fabio Santanelli di Pompeo
- Corresponding Author: Prof Fabio Santanelli di Pompeo, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sant’Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy. E-mail: ; Instagram: @diepflap.it
| | - Mark W Clemens
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA and is a Breast Surgery section editor for Aesthetic Surgery Journal
| | - Michael Atlan
- Aesthetic Plastic Reconstructive Unit/CHU TENON PARIS—APHP, Université Pierre et Marie Curie, Paris, France
| | | | - Peter G Cordeiro
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Daphne De Jong
- Amsterdam UMC-Vrije Universiteit Amsterdam, Department of Pathology and Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Arianna Di Napoli
- Pathology Unit, Department of Clinical and Molecular Medicine, Sapienza University, Sant’Andrea Hospital, Rome, Italy
| | | | - Cara L Haymaker
- Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven M Horwitz
- Lymphoma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Kelly Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Lennox
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, BC, Canada and is a clinical editor for Aesthetic Surgery Journal
| | | | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexandre M Munhoz
- Plastic Surgery Department, Hospital Moriah, Hospital Sírio-Libanês, Higienópolis, São Paulo, Brazil
| | | | - Suzanne D Turner
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Guido Firmani
- Faculty of Medicine and Psychology, Sapienza University of Rome, Department of Plastic Surgery, Sant’Andrea Hospital, Rome, Italy
| | - Michail Sorotos
- Faculty of Medicine and Psychology, Sapienza University of Rome, Department NESMOS, Sant’Andrea Hospital, Rome, Italy
| |
Collapse
|
6
|
Concerns Regarding Dishonesty in Reporting a Large Study of Patients Treated With Allergan Biocell Breast Implants. Ann Plast Surg 2022; 88:585-588. [PMID: 35443274 DOI: 10.1097/sap.0000000000003199] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
Frojo G, Nguyen D, Boyd LC, Roider L, Qureshi H, Christopher K, Xu K, Lund H. Management of Asymptomatic Patients With Textured Breast Implants: A Survey Analysis of Members of The Aesthetic Society. Aesthet Surg J 2022; 42:361-366. [PMID: 33617625 DOI: 10.1093/asj/sjab101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The management of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has been well established. However, there is minimal data and significant variability in the management of asymptomatic textured implant (ATI) patients. OBJECTIVES The purpose of this study was to survey members of The Aesthetic Society on management of ATI patients in order to understand trends in practice patterns. METHODS Members of The Aesthetic Society were queried via an electronic survey regarding management of ATI patients. Anonymous responses were collected by QualtricsXM (SAP, Walldorf, Germany) survey software. Descriptive statistics were used to examine the data, reported as frequencies. All analyses were performed with IBM SPSS Statistics 26. RESULTS The survey was sent to 2149 active and candidate members of The Aesthetic Society with a total of 470 responses (21.87% response rate). For ATI patients presenting with concerns regarding BIA-ALCL risk, 88.8% of respondents educate the patient with clinical follow-up and/or imaging. The other 11.2% of surgeons recommend implant removal with variability in capsulectomy technique. For ATI patients requesting surgery, 42.5% of respondents educate the patient with clinical follow-up and/or imaging. The majority of surgeons (57.6%) recommend removal of the implant, with 30% recommending total capsulectomies. CONCLUSIONS There is considerable variability in how members of The Aesthetic Society manage ATI patients who request surgery. Future regulatory agency and professional society collaborative efforts should continue to aim for generation of high-level scientific data to aid in the counseling and management of ATI patients. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- Gianfranco Frojo
- Division of Plastic Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - David Nguyen
- Division of Plastic Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Louisa C Boyd
- Division of Plastic Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Laura Roider
- Division of Plastic Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Hassan Qureshi
- Saint Louis University School of Medicine, St. Louis, MO, USA
| | | | - Kyle Xu
- Division of Plastic Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | | |
Collapse
|
8
|
Danilla SV, Jara RP, Miranda F, Bencina F, Aguirre M, Troncoso E, Erazo CA, Andrades PR, Sepulveda SL, Albornoz CR. Response to "Banning Textured Implants Is a Rational Decision to Eliminate the Risk of Breast Implant-Associated Anaplastic Large-Cell Lymphoma (BIA-ALCL)". Aesthet Surg J 2020; 40:NP478-NP479. [PMID: 32618330 DOI: 10.1093/asj/sjaa108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stefan V Danilla
- Division of Plastic Surgery, Department of Surgery, University Hospital of Chile, Santiago, Chile
| | - Rocio P Jara
- Division of Plastic Surgery, Department of Surgery, University Hospital of Chile, Santiago, Chile
| | - Felipe Miranda
- Center of Medical Informatics and Telemedicine, University of Chile, Santiago, Chile
| | - Francisco Bencina
- Center of Medical Informatics and Telemedicine, University of Chile, Santiago, Chile
| | - Marcela Aguirre
- Center of Medical Informatics and Telemedicine, University of Chile, Santiago, Chile
| | - Ekaterina Troncoso
- Division of Plastic Surgery, Department of Surgery, University Hospital of Chile, Santiago, Chile
| | - Cristian A Erazo
- Division of Plastic Surgery, Department of Surgery, University Hospital of Chile, Santiago, Chile
| | - Patricio R Andrades
- Division of Plastic Surgery, Department of Surgery, University Hospital of Chile, Santiago, Chile
| | - Sergio L Sepulveda
- Division of Plastic Surgery, Department of Surgery, University Hospital of Chile, Santiago, Chile
| | - Claudia R Albornoz
- Division of Plastic Surgery, Department of Surgery, University Hospital of Chile, Santiago, Chile
| |
Collapse
|