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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.
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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
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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
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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
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Allison K, Gilmour A. Breast lymphomas, breast implants and capsules The timeline of BIA-ALCL with respect to surgical consent: the UK perspective. JPRAS Open 2022; 34:41-50. [PMID: 36164587 PMCID: PMC9508381 DOI: 10.1016/j.jpra.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/04/2022] [Indexed: 10/30/2022] Open
Abstract
Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a rare type of T-Cell (non-Hodgkin's) lymphoma associated with the use of silicone breast implants. Recent widespread awareness has focused not only on the management of this condition but also in regards to potential litigation of surgeons, clinics, and breast implant manufacturers. Allegations of causation and inappropriate patient consent are being raised. The purpose of this article is to establish the timeline of relevant discoveries regarding this condition and associated implications with regards to appropriate informed patient consent.
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Tevis SE, Hunt KK, Miranda RN, Lange C, Pinnix CC, Iyer S, Butler CE, Clemens MW. Breast Implant-associated Anaplastic Large Cell Lymphoma: A Prospective Series of 52 Patients. Ann Surg 2022; 275:e245-e249. [PMID: 32568749 DOI: 10.1097/sla.0000000000004035] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to evaluate patients at a single academic institution in a prospective manner to report patient presentation, clinical course, treatment, and outcomes in breast implant ALCL patients. BACKGROUND Breast implant-associated anaplastic large cell lymphoma (breast implant ALCL) is an uncommon T cell lymphoma, which is associated with textured surface breast implants. The disease has received increasing attention over the last 20 years. Previous retrospective studies have begun to outline the clinical course of breast implant ALCL. METHODS We prospectively followed women with cytologically proven breast implant ALCL from 2014 to 2019. Demographic, clinical, treatment, and outcome data were collected and descriptive statistics were performed on variables of interest. RESULTS We identified 52 women with pathologically confirmed breast implant ALCL. Implants were placed for augmentation in 61.5% of women and reconstruction in 36.5% of women. All of the 41 patients with known implant information had implants with textured surface. The majority of patients presented with delayed seroma (69.2%) and without systemic symptoms (86.5%). Most patients with staging information presented with Stage IA disease. Patient outcomes were excellent with 2 disease recurrence (3.8%) and all patients ultimately achieved complete remission. CONCLUSIONS Further evaluation of the prospective and growing database of patients with breast implant ALCL will further improve our understanding of the disease and its clinical course. Robust participation in the breast implant ALCL PROFILE registry will improve our knowledge of long-term outcomes after implant placement. Finally, increasing awareness for patients and providers will lead to earlier diagnosis and improved outcomes for patients.
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Affiliation(s)
- Sarah E Tevis
- Department of Surgery, University of Colorado, Aurora, CO
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, TX
| | - Roberto N Miranda
- Department of Hematopathology, MD Anderson Cancer Center, Houston, TX
| | - Caitlin Lange
- Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX
| | - Chelsea C Pinnix
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | | | - Charles E Butler
- Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX
| | - Mark W Clemens
- Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX
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Thinking Outside the Black Box: Current Perceptions on Breast Implant Safety and Utility. Plast Reconstr Surg 2021; 147:593-603. [PMID: 33620927 DOI: 10.1097/prs.0000000000007626] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is growing public concern surrounding breast implant safety. In fact, the U.S. Food and Drug Administration recently proposed changes to breast implant labeling, which include a boxed warning. Given such efforts to increase transparency on breast implant safety, this study assessed laywomen's perceptions of breast implant safety, and the impact of proposed changes to breast implant labeling on laywomen's decision-making regarding breast implants. METHODS This was a cross-sectional investigation of women recruited through Amazon Mechanical Turk. Discrete choice modeling was used to query opinions on breast implants after viewing proposed labeling changes. Chi-square and analysis of variance were used for subgroup analyses, and McNemar analyses were used to assess changes in participants' responses. RESULTS The authors received 500 survey responses. At baseline, 353 participants (70.6 percent) considered breast implants to be at least somewhat safe. After viewing the proposed boxed warning, 252 participants (50.4 percent) responded that they would be less likely to receive implants. In fact, a significantly greater proportion of participants considered breast implants to be either unsafe or very unsafe after viewing suggested changes to implant labeling than at baseline (58.4 percent versus 28.8 percent; p = 0.001). By the end of the survey, willingness to consider alternative options for breast augmentation/reconstruction increased significantly from baseline. CONCLUSIONS Improved labeling can enhance laywomen's understanding of breast implant safety and can impact decision-making. However, greater scrutiny of breast implants should not prevent women who need implants from receiving them. Transparency and objectivity in the surgeon-patient dialogue can ensure the appropriate use of medical devices such as breast implants.
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Pontes GH, Mendes Carneiro Filho FS, Vargas Guerrero LA, Takahashi Rodrigues Pinto C, Serra-Guimarães F. Patient Satisfaction Following Inverted-T and Short-Scar Mammaplasty as Measured by the Breast Evaluation Questionnaire 55. Aesthet Surg J 2021; 41:NP300-NP314. [PMID: 32780109 DOI: 10.1093/asj/sjaa236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Mastopexy combined with silicone implant placement is one of the most frequently performed plastic surgeries. Various techniques have been developed to increase the degree of patient satisfaction after surgery. The goal is to give the breasts a harmonious shape, generating the smallest scars possible. The Breast Evaluation Questionnaire 55 (BEQ 55) was developed in 2006 as a tool for assessing the satisfaction and comfort of patients with the general appearance of their breasts. OBJECTIVES The objective of this study was to compare the degree of satisfaction of patients undergoing mastopexy by the inverted-T technique vs the short-scar technique by the BEQ 55. METHODS The BEQ 55 was administered pre- and postoperatively to 200 patients who underwent mastopexy performed by the first author between October 2013 and September 2017. One hundred patients underwent the short-scar technique, and 100 patients underwent the inverted-T technique. RESULTS The first analysis used descriptive statistics. Relative frequencies were used to track the responses corresponding to each technique. There was an increase in the level of patient comfort and satisfaction with breast appearance after surgery in both groups. The short-scar technique was shown to be superior, with statistical significance (P < 0.05) found for the questions evaluating comfort with overall appearance naked, comfort with breast appearance naked, and satisfaction with breast appearance. CONCLUSIONS Both techniques improved the patients' satisfaction and comfort with their breasts. When the short-scar technique was used, patients were more comfortable with their breast appearance and with their overall appearance naked. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Gisela Hobson Pontes
- Postgraduate Program in Physiopathology and Surgical Sciences, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
- Plastic Surgery Residency at Ronaldo Pontes Plastic Surgery Training Program, Niteroi D'Or Hospital, Niteroi, RJ, Brazil
| | | | | | | | - Fernando Serra-Guimarães
- Division of Plastic and Reconstructive Surgery, Pedro Ernesto University Hospital, Rio de Janeiro (UERJ), RJ, Brazil
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Decuypere F, De Wolf E, Vyncke T, Claes K, Monstrey S, Buncamper M. Male-to-female gender affirmation surgery: breast reconstruction with Ergonomix round prostheses. Int J Impot Res 2021; 33:720-725. [PMID: 33723376 DOI: 10.1038/s41443-021-00425-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/11/2021] [Accepted: 02/26/2021] [Indexed: 11/09/2022]
Abstract
People with gender dysphoria are becoming more prevalent and more universally accepted. Social, hormonal, and surgical gender transition are able to substantially improve their quality of life. Various gender affirmation surgery (GAS) options are available to address gender dysphoria in the male-to-female (MtF) population, including facial and chest feminization, body contouring, and genital surgery. While hormone replacement therapy may result in some degree of breast development, it is often insufficient to effectively result in an adequate female-like breast contour. The creation of a female chest is generally the first surgical step in the transition. The primary aim of this manuscript is to describe the surgical technique with ergonomix round prostheses used at our high-volume GAS center and to point out how anatomical differences between trans-female and cis-female patients impact surgery. Furthermore, we provide an overview of the demographic data and postoperative outcomes.
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Affiliation(s)
- Fien Decuypere
- Department of Plastic and Reconstructive Surgery, Gent University Hospital, Ghent, Belgium.
| | - Edward De Wolf
- Department of Plastic and Reconstructive Surgery, Gent University Hospital, Ghent, Belgium
| | - Tom Vyncke
- Department of Plastic and Reconstructive Surgery, Gent University Hospital, Ghent, Belgium
| | - Karel Claes
- Department of Plastic and Reconstructive Surgery, Gent University Hospital, Ghent, Belgium
| | - Stan Monstrey
- Department of Plastic and Reconstructive Surgery, Gent University Hospital, Ghent, Belgium
| | - Marlon Buncamper
- Department of Plastic and Reconstructive Surgery, Gent University Hospital, Ghent, Belgium
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Parham CS, Hanson SE, Butler CE, Calobrace MB, Hollrah R, Macgregor T, Clemens MW. Advising patients about breast implant associated anaplastic large cell lymphoma. Gland Surg 2021; 10:417-429. [PMID: 33634000 PMCID: PMC7882310 DOI: 10.21037/gs.2020.03.06] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/28/2020] [Indexed: 11/06/2022]
Abstract
The United States Food and Drug Administration (FDA) recently recognized the necessity for improved patient education and public awareness of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). BIA-ALCL is an uncommon T-cell lymphoma that can arise years after placement of a textured breast implant or tissue expander. Patients and providers would greatly benefit from a broader awareness of BIA-ALCL and how it presents with both common and rare symptoms. Disease awareness can be improved with specific steps moving forward. This includes improved counseling about annual recommendations from the FDA, standard of care guidelines, current estimates of disease prevalence, and manufacturer-specific risk for developing the malignancy. Informed consent for implant-based breast surgery should include a discussion of BIA-ALCL, symptoms, inherent risks and alternatives. Consideration should be given for reasonable efforts to retroactively contact patients with textured implants to inform them of recent regulatory actions as well as the risk of developing the disease and the signs and symptoms to watch for. Where risk can be reduced, all steps should be taken to ensure patient safety. In keeping with our commitment to patient safety, the strategies moving forward for implant-based breast surgery should be marked by patient awareness, physician vigilance, and defined by evidence-based diagnosis and treatment.
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Affiliation(s)
- Christopher S. Parham
- Department of Surgery, Division of Plastic Surgery, Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Summer E. Hanson
- Department of Plastic Surgery, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Charles E. Butler
- Department of Plastic Surgery, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - M. Bradley Calobrace
- CaloAesthetics Plastic Surgery Center; Clinical Faculty Member, Divisions of Plastic Surgery, University of Louisville and University of Kentucky, Louisville and Lexington, KY, USA
| | | | | | - Mark W. Clemens
- Department of Plastic Surgery, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
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Sutton EJ, Dashevsky BZ, Watson EJ, Tyagi N, Bernard‐Davila B, Martinez D, Dogan A, Horwitz SM, Cordeiro PG, Morris EA. Incidence of benign and malignant peri-implant fluid collections and masses on magnetic resonance imaging in women with silicone implants. Cancer Med 2020; 9:3261-3267. [PMID: 31568670 PMCID: PMC7221432 DOI: 10.1002/cam4.2189] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/20/2019] [Accepted: 04/08/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To assess the incidence of benign and malignant peri-implant fluid collections and/or masses on magnetic resonance imaging (MRI) in women with silicone implants who are being screened for silent implant rupture. METHODS The institutional review board approved this HIPAA-compliant retrospective study and waived informed consent. Women who underwent silicone implant oncoplastic and/or cosmetic surgery and postoperative implant-protocol MRI from 2000 to 2014 were included. Peri-implant fluid collections and/or masses were measured volumetrically. A benign peri-implant fluid collection and/or mass was pathologically proven or defined as showing 2 years of imaging and/or clinical stability. A malignant peri-implant fluid collection was pathologically proven. Incidence of peri-implant fluid collections and/or masses and positive predictive value (PPV) were calculated on a per-patient level using proportions and exact 95% confidence intervals (CIs). Fisher's exact test was used in the analysis to test statistical significance pre-defined as P-value < 0.05. RESULTS A total of 1070 women with silicone implants were included (mean age, 50.7 years; range, 40.4-53.8). Median time between reconstructive surgery and first MRI was 88.9 months (range, 0.8-1363.3). Eighteen women (1.7%) had a peri-implant fluid collection and/or mass: 15/18 (83.3%) had adequate follow-up; and only 1/15 was malignant implant associated anaplastic large cell lymphoma, with a PPV of 6.7% (95% CI: 0.003-0.0005). The median peri-implant fluid collection size was 89 mL (range, 18-450 mL). CONCLUSION Peri-implant fluid collections and/or masses identified at silicone implant protocol breast MR imaging are rarely seen 24 months after reconstructive surgery. Image-guided fine-needle aspiration with flow cytometry may be warranted to evaluate for implant-associated lymphoma.
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Affiliation(s)
- Elizabeth J. Sutton
- Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Brittany Z. Dashevsky
- Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkNew York
- Department of RadiologyUniversity of CaliforniaSan FranciscoCalifornia
| | - Elizabeth J. Watson
- Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkNew York
- Department of RadiologyUniversity of VermontBurlingtonVermont
| | - Neelam Tyagi
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | | | - Danny Martinez
- Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Ahmet Dogan
- Department of Pathology and Laboratory MedicineMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Steven M. Horwitz
- Departmemt of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Peter G. Cordeiro
- Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Elizabeth A. Morris
- Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkNew York
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K Groth A, Graf R. Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) and the Textured Breast Implant Crisis. Aesthetic Plast Surg 2020; 44:1-12. [PMID: 31624894 DOI: 10.1007/s00266-019-01521-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 10/05/2019] [Indexed: 12/26/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon T-cell, CD-30+/ALK lymphoma. Late (9 years) periprosthetic fluid (seroma) is the most common presentation (90% of the cases). A combination of textured breast implant, bacterial contamination, and genetic predisposition seems to be necessary for BIA-ALCL to occur. There are 35 million patients with implants in the world, and at the present moment, 573 cases of BIA-ALCL have been reported. The risk of developing BIA-ALCL in Australia varies from 1:2832 to 1:86,029, with texture grades 3 and 4 seeming to pose a higher risk than grades 2 and 1. NCCN has established guidelines for diagnosis and treatment, and early diagnosis is the key to cure. At an early stage and for the vast majority of patients, the treatment consists of capsulectomy and implant removal. However, at stages II to IV, a systemic treatment is warranted, including chemotherapy, radiotherapy (residual disease), and brentuximab vedotin. The majority of patients can be cured, and complete capsular removal is the most important factor. So far, 33 patients have died from BIA-ALCL worldwide, with deaths related to delay in diagnosis and treatment. Textured implants have been in the midst of the current implant crisis, and Biocell was recalled worldwide after the latest FDA update on the disease. At the present moment, no medical society or regulatory agency has recommended implant removal. It is about time that we start robust breast implant registries to determine risks. Besides, based on scientific criteria, we must consider all the benefits and risks associated with the available breast devices.Level of Evidence III 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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Affiliation(s)
- Anne K Groth
- Brazilian Society of Plastic Surgery, Curitiba, Brazil.
- Plastic Surgery and Microsurgery Department, Erasto Gaertner Hospital, Curitiba, PR, Brazil.
- Positivo University Medical School, Curitiba, Brazil.
- , Curitiba, Brazil.
| | - Ruth Graf
- Brazilian Society of Plastic Surgery, Curitiba, Brazil
- Federal University of Parana, Curitiba, Brazil
- Pieta Medical Center, Rua Solimões 1175, Curitiba, PR, Brazil
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Breast implant-associated anaplastic large cell lymphoma: A comprehensive review. Cancer Treat Rev 2020; 84:101963. [PMID: 31958739 DOI: 10.1016/j.ctrv.2020.101963] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/28/2019] [Accepted: 01/05/2020] [Indexed: 12/12/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently recognized non-Hodgkin lymphoma of T-cell origin. Despite the low incidence of this new disease, the increasing use of breast implants for cosmetic or post-mastectomy reconstruction purposes places BIA-ALC as an emerging and compelling medical challenge. The real BIA-ALCL pathogenesis has not been fully uncovered so far, while different putative causal factors have been proposed. Breast implants with textured surfaces seem to be associated with nearly all cases of BIA-ALCL, while the real the risk of disease development has not been well estimated so far. Late onset, persistent seroma around breast implant represents the classical clinical presentation. Most of the BIA-ALCL patients presents with localized disease, which confers an excellent prognosis. Unlike other non-Hodgkin lymphomas, surgical excision of the mass has a key role in the treatment. For patients with advanced and disseminated diseases, the treatment did not differ from other types of T-cell lymphoma. For these reasons, BIA-ALCL represents an emerging disease which requires multidisciplinary team approach to well define diagnostic workup and treatment for each patient. This review article aims to summarize available data on BIA-ALCL. First, we will outline available data on BIA-ALCL epidemiology, pathogenesis, diagnostic work-up, and treatment. Second, we will point out the potential psychological implications as well as the risk of perception distortion for women with breast implants, especially for those with previous breast cancer. Lastly, we will summarize the current national recommendations regarding textured breast implants and discuss the diagnostic-therapeutic algorithm for BIA-ALCL management.
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13
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Abstract
BACKGROUND Breast ptosis is an inevitable consequence of gravity and time. Every breast tends to become ptotic in different shapes and degrees. Many surgical techniques were described to solve this problematic issue. The aim of this article is to describe a mastopexy technique used for grades 1 to 2 ptosis, "tuck-in" mastopexy technique. METHODS Keyhole pattern was used for skin markings. All the planned skin excision areas were de-epithelialized. Breast mound was elevated as a 1-piece flap with extensive subglandular dissection. Elevated breast flap was reshaped and repositioned. Skin incisions were sutured in 2 layers. RESULTS Seventeen patients were operated on with this technique; average follow-up time was 10.1 months. No major complications were seen. The results were pleasing for both the patients and the surgeon. CONCLUSIONS The "tuck-in" mastopexy technique uses breast mound as 1-piece flap, which has great vascularity from medial, superior, and lateral pedicles. Large areas of de-epithelialization facilitate reshaping and repositioning. It permits simultaneous or secondary breast augmentation with silicone gel implants. This easy-to-do technique has low complication rates and a short learning period.
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Current Risk Estimate of Breast Implant-Associated Anaplastic Large Cell Lymphoma in Textured Breast Implants. Plast Reconstr Surg 2019; 143:30S-40S. [PMID: 30817554 DOI: 10.1097/prs.0000000000005567] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND With breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) now accepted as a unique (iatrogenic) subtype of ALCL directly associated with textured breast implants, we are now at a point where a sound epidemiologic profile and risk estimate are required. The aim of this article is to provide a comprehensive and up-to-date global review of the available epidemiologic data and literature relating to the incidence, risk, and prevalence of BIA-ALCL. METHODS All current literature relating to the epidemiology of BIA-ALCL was reviewed. Barriers relating to sound epidemiologic study were identified, and trends relating to geographical distribution, prevalence of breast implants, and implant characteristics were analyzed. RESULTS Significant barriers exist to the accurate estimate of both the number of women with implants (denominator) and the number of cases of BIA-ALCL (numerator), including poor registries, underreporting, lack of awareness, cosmetic tourism, and fear of litigation. The incidence and risk of BIA-ALCL have increased dramatically from initial reports of 1 per million to current estimates of 1/2,832, and is largely dependant on the "population" (implant type and characteristics) examined and increased awareness of the disease. CONCLUSIONS Although many barriers stand in the way of calculating accurate estimates of the incidence and risk of developing BIA-ALCL, steady progress, international registries, and collegiality between research teams are for the first time allowing early estimates. Most striking is the exponential rise in incidence over the last decade, which can largely be explained by the increasingly specific implant subtypes examined-driven by our understanding of the pathologic mechanism of the disease. High-textured high-surface area implants (grade 4 surface) carry the highest risk of BIA-ALCL (1/2,832).
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Mukhtar RA, Holland M, Sieber DA, Wen KW, Rugo HS, Kadin ME, Bean GR. Synchronous Breast Implant-associated Anaplastic Large Cell Lymphoma and Invasive Carcinoma: Genomic Profiling and Management Implications. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2188. [PMID: 31321184 PMCID: PMC6554181 DOI: 10.1097/gox.0000000000002188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/25/2019] [Indexed: 01/17/2023]
Abstract
A 59-year-old woman with a history of cosmetic implants developed ipsilateral synchronous breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and invasive ductal carcinoma in the left breast. Each tumor was subjected to next-generation sequencing, and separate analyses revealed mutually exclusive aberrations: an activating STAT3 mutation in the lymphoma and a PIK3CA in-frame deletion in the carcinoma. The patient was treated with removal of implants, capsulectomy, partial mastectomy, sentinel node biopsy, radiotherapy, and endocrine therapy with no evidence of recurrence for 1 year. This case illustrates the importance of obtaining thorough evaluation for concomitant malignancies in the breast at the time of diagnosis of BIA-ALCL. Herein, we review the current recommendations for evaluation and management of BIA-ALCL.
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Affiliation(s)
- Rita A Mukhtar
- Department of Surgery, University of California San Francisco, San Francisco, Calif
| | - Michael Holland
- Department of Surgery, University of California San Francisco, San Francisco, Calif
| | | | - Kwun Wah Wen
- Department of Pathology, University of California San Francisco, San Francisco, Calif
| | - Hope S Rugo
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco; San Francisco, Calif
| | - Marshall E Kadin
- Department of Dermatology and Skin Surgery, Boston University School of Medicine; Boston, Mass
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, R.I
| | - Gregory R Bean
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
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Abstract
LEARNING OBJECTIVES After reading this article, the participant should be able to: 1. Develop a practical method for preoperative implant size selection. 2. List characteristics and examples of fourth- and fifth-generation silicone implants. 3. Recognize the differences in "profile" designations across implant manufacturers. 4. Recall updated statistics on breast implant-associated anaplastic large cell lymphoma and describe current guidelines on disease diagnosis and treatment. 5. Apply atraumatic and aseptic surgical techniques in primary breast augmentation. SUMMARY Modern primary breast augmentation requires an intimate knowledge of the expanding breast implant market, including characteristics of current generation silicone implants and "profile" types. Optimal implant size selection requires balancing patient desires with tissue qualities. Evidence and awareness of breast implant-associated anaplastic large cell lymphoma continue to grow, and patients and surgeons alike should be informed on the most updated facts of the disease entity. Atraumatic surgical technique and aseptic adjuncts are critical in reducing periprosthetic inflammation and contamination, both of which are known instigators of capsular contracture and potentially breast implant-associated anaplastic large cell lymphoma.
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Quesada AE, Medeiros LJ, Clemens MW, Ferrufino-Schmidt MC, Pina-Oviedo S, Miranda RN. Breast implant-associated anaplastic large cell lymphoma: a review. Mod Pathol 2019; 32:166-188. [PMID: 30206414 DOI: 10.1038/s41379-018-0134-3] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/31/2018] [Accepted: 06/02/2018] [Indexed: 12/23/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma is a newly recognized provisional entity in the 2017 revision of the World Health Organization Classification of Tumors of Hematopoietic and Lymphoid Tissues. It is an uncommon, slow growing T-cell lymphoma with morphology and immunophenotype similar to anaplastic lymphoma kinase-negative anaplastic large cell lymphoma. However, the presentation and treatment are unique. Breast implant-associated anaplastic large cell lymphoma often presents as a unilateral effusion confined to the capsule of a textured-surface breast implant, a median time of 9 years after the initial implants have been placed. Although it follows an indolent clinical course, breast implant-associated anaplastic large cell lymphoma has the potential to form a mass, to invade locally through the capsule into breast parenchyma or soft tissue and/or to spread to regional lymph nodes. In most cases, an explantation with a complete capsulectomy removing all disease, without chemotherapy is considered to be curative and confers an excellent event free and overall survival. Here we provide a comprehensive review of breast implant-associated anaplastic large cell lymphoma, including history, epidemiology, clinical features, imaging and pathology findings, pathologic handling, pathogenic mechanisms, model for progression, therapy and outcomes as well as an analysis of causality between breast implants and anaplastic large cell lymphoma.
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Affiliation(s)
- Andrés E Quesada
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark W Clemens
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Sergio Pina-Oviedo
- Department of Pathology and Laboratory Services, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Srinivasa DR, Holland M, Sbitany H. Optimizing perioperative strategies to maximize success with prepectoral breast reconstruction. Gland Surg 2019; 8:19-26. [PMID: 30842924 DOI: 10.21037/gs.2018.09.10] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Implant based reconstruction is still the most commonly employed method of post mastectomy reconstruction in the United States and internationally. Mastectomy techniques are improving, and adjuncts such as tissue perfusion technology and biologic implants allow for re-evaluation of traditional reconstructive methods. Subpectoral implant placement is used in a large majority of patients undergoing implant based reconstruction. However, with the advent of acellular dermal matrix (ADM), a "sling" for the expander and implant can be placed with surgical precision to create the optimal breast pocket. This has allowed for placement of the breast prosthesis in a prepectoral anatomic plane. The benefits are clear: avoidance of animation deformities and a significant decrease in pain that results from pectoralis mobilization and spasm. Here, we discuss specific techniques to avoid pitfalls and optimize aesthetic results with prepectoral breast reconstruction. Patient selection, intra-operative mastectomy flap evaluation, modifications in expander and implant fill, and technique specifics all play a critical role in this new, and rapidly growing method for implant based breast reconstruction.
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Affiliation(s)
- Dhivya R Srinivasa
- Division of Plastic and Reconstructive Surgery, University of California, San Francisco, CA, USA
| | - Michael Holland
- Division of Plastic and Reconstructive Surgery, University of California, San Francisco, CA, USA
| | - Hani Sbitany
- Division of Plastic and Reconstructive Surgery, University of California, San Francisco, CA, USA
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Abstract
Breast implants have been shadowed in controversy since their introduction to the market; however, they represent a multi-million dollar industry and play a critical role both for cosmetic augmentation and enhancement and for reconstruction following treatment for cancer. With advancements in technology, breast implants have evolved tremendously over the years. Further, with the cessation of the FDA implemented moratorium on silicone, the use of silicone implants has grown exponentially over the years. Novel designs in the outer shell, breast implant fill particularly the cohesivity of the silicone gel, texturing of the outer shell, and the shape and projection of breast implants have produced a broad array of implants that can be employed by plastic and reconstructive surgeons to maximize outcomes for patients. However, despite the innovations in breast implant design and engineering, it is unclear whether these have had any influence on outcomes and patient satisfaction. The present article aims to provide a comprehensive review of the technological advancements in breast implant technology in optimizing patient outcomes and minimizing complications associated with placement of breast implants for aesthetic as well as reconstructive procedures. The article will provide a synopsis of round versus shaped breast implants, saline versus silicone especially the advent of cohesive silicone gel implants, and the texturing of the outer shell, and how each of these components should be considered when counseling patients and deciding which implants offer the optimal benefits for each individual patient.
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Autoinflammatory/autoimmunity syndrome induced by adjuvants (ASIA; Shoenfeld's syndrome): A new flame. Autoimmun Rev 2018; 17:1259-1264. [PMID: 30316995 DOI: 10.1016/j.autrev.2018.07.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 07/18/2018] [Indexed: 12/29/2022]
Abstract
In the present review, recent findings regarding autoimmune/inflammatory syndrome by adjuvants (ASIA) are described. Patients with ASIA present with complaints such as fatigue, cognitive impairment, arthralgias, myalgias, pyrexia, dry eyes and dry mouth. During the last few years, it has been postulated that these symptoms in patients with foreign body implants are due to a chronic inflammatory process and an adjuvant effect of the implanted biomaterial. Ultimately, these inflammatory reactions result in (an increase of) allergies, autoimmune diseases, immune deficiency and/or lymphomas. Pre-existent allergic disease has been found to be an important risk factor for the development of ASIA after foreign body implantation. Explantation of the foreign body results in the majority of patients in an amelioration of the symptoms. There is an urgent need to start adequately adjusted epidemiological studies to obtain better evidence which percentage of patients does develop symptoms and/or diseases such as ASIA, immune deficiency, and/or autoimmune diseases after implant surgery.
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Ramos-Gallardo G, Cuenca-Pardo J, Cardenas-Camarena L, Duran-Vega H, Rodríguez-Olivares E, Bayter-Marin JE, Levelier De Doig Alvear G, Vazquez G, Fontbona-Torres M, Galán-Suárez R, Guzman-Stein G, Guzmán-Padilla S, Echeverría-Roldán G, Silva-Gavarrete JF, Vallarta-Rodríguez A, Contreras-Bulnes L, Oaxaca-Escobar CG, Caravantes-Cortes I, Flores ME, Cowes-McGowen J, Maciel-Sosa ML, Delgado-Binasco R, Rincón-Rubio L. Is Latin America Ready to Identify Anaplastic Large Cell Lymphoma in Breast Implants Patients? Regional Encounter During the National Plastic Surgery Meeting in Cancun, Mexico. Aesthetic Plast Surg 2018; 42:1421-1428. [PMID: 29770862 DOI: 10.1007/s00266-018-1148-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 04/28/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Anaplastic large cell lymphoma associated with breast implants is receiving increased attention. Most cases have been reported in Europe, North America (USA and Canada), Australia and New Zealand. Fewer cases have been reported in Latin America (including Mexico), Africa and Asia. METHODS This report was delivered during our national plastic surgery meeting in Cancun in May 2017. Before the meeting, two participants reviewed the literature. The review was performed using the following information sources: PubMed, Embase, Cochrane, Fisterra, Google Scholar and LILACS, with entries from 1980 to August 2015 in several languages (English, Spanish, French and Portuguese). The results were revealed during the meeting to the other participants. The consensus was divided into two parts. The first part included an open-ended question regarding the incidence and prevalence of the problem. The second part included clinical scenarios with different items that were rated by the participants. After this activity, accordance among the responses was evaluated. RESULTS Seven cases were reported during the meeting (3 from Mexico, 3 from Chile and 1 from Argentina). Fifty percent of the participants reported consulting with guidelines and clinical centers to help with potential cases. Most agreed that further studies must be done in cases of chronic seroma where the capsule plays an important role. DISCUSSION A current debate exists about the incidence of this problem in Latin America because we did not report the same number of cases as Europe, Australia or North America. More studies are required to determine the differences among reports in Latin America. CONCLUSION Most representatives agreed that further studies must be done. Concern is increasing, and the problem is known. Other factors involved may be considered, and the problem must not be ignored. NO LEVEL ASSIGNED 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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Affiliation(s)
- Guillermo Ramos-Gallardo
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico.
| | - Jesus Cuenca-Pardo
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Lazaro Cardenas-Camarena
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Hector Duran-Vega
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Eugenio Rodríguez-Olivares
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Jorge Enrique Bayter-Marin
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Gerardo Levelier De Doig Alvear
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Guillermo Vazquez
- Sociedad Argentina de Cirugía Plástica Estética y Reconstructiva, Federación Iberolatinoamericana de Cirugía Plástica, Buenos Aires, Argentina
| | | | - Ricardo Galán-Suárez
- Sociedad Colombiana de Cirugía Plástica Estética y Reconstructiva, Cartagena, Colombia
| | - Gabriela Guzman-Stein
- Asociación Costarricense de Cirugía Plástica Estética y Reconstructiva, San José, Costa Rica
| | - Sergio Guzmán-Padilla
- Sociedad Dominicana de Cirugía Plástica Reconstructiva y Estética, Punta Cana, Dominican Republic
| | | | | | - Alfonso Vallarta-Rodríguez
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Livia Contreras-Bulnes
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Carlos Guillemro Oaxaca-Escobar
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Isabel Caravantes-Cortes
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | | | - Jorge Cowes-McGowen
- Asociación Panameña de Cirugía Plástica Estética y Reconstructiva, Panama City, Panama
| | - María Liz Maciel-Sosa
- Sociedad Paraguaya de Cirugía Plástica Estética y Reconstructiva, Asunción, Paraguay
| | | | - Linda Rincón-Rubio
- Sociedad Venezolana de Cirugía Plástica Estética, Reconstructiva y Maxilofacial, Caracas, Venezuela
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How to Diagnose and Treat Breast Implant-Associated Anaplastic Large Cell Lymphoma. Plast Reconstr Surg 2018; 141:586e-599e. [PMID: 29595739 DOI: 10.1097/prs.0000000000004262] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
LEARNING OBJECTIVES After reading this article, the participant should be able to: 1. Describe the diagnostic criteria for breast implant-associated (BIA) anaplastic large cell lymphoma (ALCL). 2. Appropriately evaluate a patient with suspected BIA-ALCL, including appropriate imaging, laboratory tests, and pathologic evaluation. 3. Understand the operative treatment of BIA-ALCL, and indications for systemic chemotherapy and/or radiation therapy in advanced disease. 4. Understand treatment outcomes and prognosis based on stage of disease. SUMMARY The goal of this continuing medical education module is to present the assessment of a patient with suspected breast implant-associated anaplastic large cell lymphoma, the evaluation and diagnosis, the preoperative oncologic workup, the formation and execution of a surgical treatment plan, and the inclusion of adjunct treatments when indicated. In addition, staging and disease progression for treatment of breast implant-associated anaplastic large cell lymphoma are discussed.
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Svee A, Mani M, Sandquist K, Audolfsson T, Folkvaljon Y, Isern AE, Ringberg A, Manjer J, Falk-Delgado A, Wärnberg F. Survival and risk of breast cancer recurrence after breast reconstruction with deep inferior epigastric perforator flap. Br J Surg 2018; 105:1446-1453. [PMID: 29999520 DOI: 10.1002/bjs.10888] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/25/2018] [Accepted: 04/07/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Women who undergo autologous breast reconstruction have been reported to have an increased risk of breast cancer recurrence compared with those who have mastectomy alone. It has been suggested that more extensive surgery possibly activates dormant micrometastases. The aim of this study was to evaluate whether delayed unilateral deep inferior epigastric perforator (DIEP) flap reconstruction after mastectomy increases the risk of breast cancer recurrence or affects mortality among women previously treated for breast cancer. METHODS This was a matched retrospective cohort study including women with a previous unilateral invasive breast cancer who received a delayed DIEP flap breast reconstruction and a control cohort of individually matched women with unilateral breast cancer who underwent mastectomy but no autologous breast reconstruction. Matching criteria comprised: year of diagnosis (+/-3 years), age at diagnosis (+/-5 years), type of cancer and demographic region. The primary endpoints were local recurrence or distant metastasis, and overall mortality was a secondary endpoint. Absolute risk of recurrent disease and mortality was analysed, and relative risks were estimated using Cox proportional hazards analysis. RESULTS There were 225 women in the DIEP cohort and 450 in the no-DIEP cohort. The median follow-up time was 125 months. There was no difference in absolute risk of recurrence between the cohorts. The hazard ratio for breast cancer recurrence in DIEP versus no-DIEP cohorts was 0·76 (95 per cent c.i. 0·47 to 1·21). CONCLUSION There is no increased risk in breast cancer recurrence after delayed DIEP flap reconstruction compared with mastectomy alone.
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Affiliation(s)
- A Svee
- Department of Plastic and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden
| | - M Mani
- Department of Plastic and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden
| | - K Sandquist
- Department of Plastic and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden
| | - T Audolfsson
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
| | - Y Folkvaljon
- Department of Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - A E Isern
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Volvat Stokkan, Trondheim, Norway
| | - A Ringberg
- Department of Plastic and Reconstructive Surgery, Lund University, Malmö, Sweden
| | - J Manjer
- Department of Surgery, Skåne University Hospital Malmö, Lund University, Malmö, Sweden
| | - A Falk-Delgado
- Department of Plastic and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden
| | - F Wärnberg
- Department of Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Brown MH. Commentary on: Current Trends in Breast Augmentation: An International Analysis. Aesthet Surg J 2018; 38:149-150. [PMID: 29106472 DOI: 10.1093/asj/sjx125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mitchell H Brown
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon neoplasia occurring in women with either cosmetic or reconstructive breast implants. The actual knowledge about BIA-ALCL deriving from the literature presents several limits, and it remains difficult to make inferences about BIA-ALCL epidemiology, cause, and pathogenesis. This is the reason why the authors decided to organize an evidence-based consensus conference during the Maurizio Bruno Nava (MBN 2016) Aesthetic Breast Meeting held in Milan in December of 2016. Twenty key opinion leaders in the field of plastic surgery from all over the world have been invited to express and discuss their opinion about some key questions on BIA-ALCL, trying to reach a consensus about BIA-ALCL cause, pathogenesis, diagnosis, and treatment in light of the actual best evidence.
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Calobrace MB, Schwartz MR, Zeidler KR, Pittman TA, Cohen R, Stevens WG. Long-Term Safety of Textured and Smooth Breast Implants. Aesthet Surg J 2017; 38:38-48. [PMID: 29040370 DOI: 10.1093/asj/sjx157] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In this review, the authors provide a 20-year review and comparison of implant options and describe the evolution of breast implant surface textures; compare available implant surfaces; present long-term safety data from the 10-year US-based Core clinical studies; list the key benefits and risks associated with smooth and textured implants; and provide perspectives on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). The authors explore the key benefits and risks associated with all available devices so that optimal and safe patient outcomes can be achieved.
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Affiliation(s)
- M Bradley Calobrace
- Division of Plastic Surgery, University of Louisville, Louisville, KY
- Division of Plastic Surgery, University of Kentucky, Lexington, KY
| | | | | | | | | | - W Grant Stevens
- Division of Plastic Surgery, University of Southern California School of Medicine
- University of Southern California - Marina del Rey Aesthetic Surgery Fellowship Program, Los Angeles, CA
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Five-Year Safety Data for More than 55,000 Subjects following Breast Implantation: Comparison of Rare Adverse Event Rates with Silicone Implants versus National Norms and Saline Implants. Plast Reconstr Surg 2017; 140:666-679. [PMID: 28953716 DOI: 10.1097/prs.0000000000003711] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The U.S. Food and Drug Administration has required postapproval studies of silicone breast implants to evaluate the incidence of rare adverse events over 10 years after implantation. METHODS The Breast Implant Follow-Up Study is a large 10-year study (>1000 U.S. sites) evaluating long-term safety following primary augmentation, revision-augmentation, primary reconstruction, or revision-reconstruction with Natrelle round silicone breast implants compared with national norms and outcomes with saline implants. Targeted adverse events in subjects followed for 5 to 8 years included connective tissue diseases, neurologic diseases, cancer, and suicide. RESULTS The safety population comprised 55,279 women (primary augmentation, n = 42,873; revision-augmentation, n = 6837; primary reconstruction, n = 4828; and revision-reconstruction, n = 741). No targeted adverse events occurred at significantly greater rates in silicone implant groups versus national norms across all indications. The standardized incidence rate (observed/national norm) for all indications combined was 1.4 for cervical/vulvar cancer, 0.8 for brain cancer, 0.3 for multiple sclerosis, and 0.1 for lupus/lupus-like syndrome. Silicone implants did not significantly increase the risk for any targeted adverse events compared with saline implants. The risk of death was similar with silicone versus saline implants across all indications. The suicide rate (10.6 events per 100,000 person-years) was not significantly higher than the national norm. No implant-related deaths occurred. CONCLUSIONS Results from 5 to 8 years of follow-up for a large number of subjects confirmed the safety of Natrelle round silicone implants, with no increased risk of systemic disease or suicide versus national norms or saline implants. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Breast Implant–Associated Anaplastic Large Cell Lymphoma in Australia and New Zealand. Plast Reconstr Surg 2017; 140:645-654. [DOI: 10.1097/prs.0000000000003654] [Citation(s) in RCA: 246] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
LEARNING OBJECTIVES After reading this article, the participant should be able to: 1. Understand the key decisions in patient evaluation for cosmetic breast augmentation. 2. Cite key decisions in preoperative planning. 3. Discuss the risks and complications, and key patient education points in breast augmentation. SUMMARY Breast augmentation remains one of the most popular procedures in plastic surgery. The integral information necessary for proper patient selection, preoperative assessment, and surgical approaches are discussed. Current data regarding long term safety and complications are presented to guide the plastic surgeon to an evidence-based approach to the patient seeking breast enhancement to obtain optimal results.
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Abstract
BACKGROUND Breast implant-associated anaplastic large cell lymphoma (ALCL) is a distinctive type of T-cell lymphoma that arises around breast implants. Although rare, all cases with adequate history have involved a textured breast implant. The objective of this study was to determine the U.S. incidence and lifetime prevalence of breast implant-associated ALCL in women with textured breast implants. METHODS This is a retrospective review of documented cases of breast implant-associated ALCL in the United States from 1996 to 2015. The incidence and prevalence were determined based on a literature and institutional database review of breast implant-associated ALCL cases and textured breast implant sales figures from implant manufacturers' annualized data. RESULTS One hundred pathologically confirmed breast implant-associated ALCL cases were identified in the United States. Mean age at diagnosis was 53.2 ± 12.3 years. Mean interval from implant placement to diagnosis was 10.7 ± 4.6 years. Forty-nine patients had breast implants placed for cosmetic reasons, 44 for mastectomy reconstruction, and seven for unknown reasons. Assuming that breast implant-associated ALCL occurs only in textured breast implants, the incidence rate is 2.03 per 1 million person-years (203 per 100 million person-years), which is 67.6 times higher than that of primary ALCL of the breast in the general population (three per 100 million per year; p < 0.001). Lifetime prevalence was 33 per 1 million persons with textured breast implants. CONCLUSIONS This study demonstrates a statistically significant association between textured breast implants and breast implant-associated ALCL. Although women with a textured breast implant have a low risk of developing breast implant-associated ALCL, the current U.S. incidence is significantly higher than that of primary ALCL of the breast in the general population.
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Kaartinen I, Sunela K, Alanko J, Hukkinen K, Karjalainen-Lindsberg ML, Svarvar C. Breast implant-associated anaplastic large cell lymphoma – From diagnosis to treatment. Eur J Surg Oncol 2017. [DOI: 10.1016/j.ejso.2017.05.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Johnson L, O'Donoghue J, McLean N, Turton P, Khan A, Turner S, Lennard A, Collis N, Butterworth M, Gui G, Bristol J, Hurren J, Smith S, Grover K, Spyrou G, Krupa K, Azmy I, Young I, Staiano J, Khalil H, MacNeill F. Breast implant associated anaplastic large cell lymphoma: The UK experience. Recommendations on its management and implications for informed consent. Eur J Surg Oncol 2017; 43:1393-1401. [DOI: 10.1016/j.ejso.2017.05.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/21/2017] [Accepted: 05/08/2017] [Indexed: 12/31/2022] Open
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O’Neill AC, Zhong T, Hofer SOP. Implications of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) for Breast Cancer Reconstruction: An Update for Surgical Oncologists. Ann Surg Oncol 2017; 24:3174-3179. [DOI: 10.1245/s10434-017-6014-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Indexed: 12/17/2022]
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Textured Breast Implants, Anaplastic Large-Cell Lymphoma, and Conflict of Interest. Plast Reconstr Surg 2017; 139:558e-559e. [PMID: 28125539 DOI: 10.1097/prs.0000000000002966] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pannucci CJ, Cyr AJ, Moores NG, Young JB, Szegedi M. A Ballistics Examination of Firearm Injuries Involving Breast Implants. J Forensic Sci 2017; 63:571-576. [PMID: 28683519 DOI: 10.1111/1556-4029.13589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/01/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
Abstract
This ballistics study examines whether saline breast implants can decrease tissue penetration in firearm injuries. We hypothesize that the fluid column within a saline breast implant can alter bullet velocity and/or bullet pattern of mushrooming. The two experimental groups included saline implants with 7.4 cm projection and a no implant group. The experimental design allowed the bullet to pass-through an implant and into ballistics gel (n = 10) or into ballistics gel without passage through an implant (n = 11). Shots that passed through an implant had 20.6% decreased penetration distance when compared to shots that did not pass-through an implant; this difference was statistically significant (31.9 cm vs. 40.2 cm, p < 0.001). Implant group bullets mushroomed prior to gel entry, but the no implant group mushroomed within the gel. Bullet passage through a saline breast implant results in direct bullet velocity reduction and earlier bullet mushrooming; this causes significantly decreased ballistics gel penetration.
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Affiliation(s)
- Christopher J Pannucci
- Division of Plastic Surgery, Division of Health Services Research, University of Utah, Salt Lake City, UT
| | - Adam J Cyr
- ARCCA Incorporated Forensic Engineering, Seattle, WA
| | - Neal G Moores
- Division of Plastic Surgery, University of Utah, Salt Lake City, UT
| | - Jason B Young
- Division of Acute Care Surgery, University of Utah, Salt Lake City, UT
| | - Martin Szegedi
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
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Clemens MW, Nava MB, Rocco N, Miranda RN. Understanding rare adverse sequelae of breast implants: anaplastic large-cell lymphoma, late seromas, and double capsules. Gland Surg 2017; 6:169-184. [PMID: 28497021 DOI: 10.21037/gs.2016.11.03] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) is a distinct type of T-cell lymphoma arising around breast implants. The United States FDA recently updated the 2011 safety communication, warning that women with breast implants may have a very low risk of developing ALCL adjacent to a breast implant. According to the World Health Organization, BI-LCL is not a breast cancer or cancer of the breast tissue; it is a lymphoma, a cancer of immune cells. BI-ALCL is highly curable in the majority of patients. Informed consent should include the risk of BI-ALCL with breast implant patients. Women with breast implants are encouraged to contact their plastic surgeon if they notice swelling, fluid collections, or unexpected changes in breast shape. Physicians are encouraged to send suspicious peri-prosthetic fluid for CD30 immunohistochemistry, cell block cytology, and culture in symptomatic patients. An observation from reported cases indicates a predominance of textured device involvement. More information is needed to fully understand risk factors and etiology. The association of bacteria and biofilm with ALCL is currently being investigated and one theory is that biofilm may play a role in this disease process stressing the importance of best practice techniques intraoperatively. Recent studies have reported clinical presentation, prognosis, and treatment outcomes with long term followup demonstrating the critical role for surgical management.
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Affiliation(s)
- Mark W Clemens
- Department of Plastic Surgery, M.D. Anderson Cancer Center, Houston, TX, USA
| | | | - Nicola Rocco
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Roberto N Miranda
- Department of Hematopathology, the University of Texas M.D. Anderson Cancer, Center, Houston, TX, USA
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