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Tajiri W, Shimamoto R, Koga Y, Kawasaki J, Higuchi M, Nakamura Y, Koi Y, Koga C, Ijichi H, Choi I, Suehiro Y, Taguchi K, Tokunaga E. A case of BIA-ALCL in which postoperative chest wall recurrence was highly suspected: the third reported case of BIA-ALCL in Japan. Surg Case Rep 2024; 10:196. [PMID: 39177840 PMCID: PMC11343931 DOI: 10.1186/s40792-024-01996-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 08/14/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare malignancy. Many cases of BIA-ALCL are identified based on the presence of late-onset effusion and/or masses. Importantly, the United States Food and Drug Administration noted that in all cases diagnosed in patients with textured implants, the patients either had a history of mixed implantation of smooth and textured devices or no clinical history was supplied for review. In Japan, the first case of BIA-ALCL was reported in 2019, and we encountered the third case in Japan in December 2021. There have been a total of five cases of BIA-ALCL previously reported at Japanese academic conferences (Japan Oncoplastic Breast Surgery Society. http://jopbs.umin.jp/medical/index.html ), of which only the first case has been published. Unlike the first case, this patient had clinical features that were highly suggestive of the postoperative chest wall recurrence of breast cancer, with a mass and rash on the skin. CASE PRESENTATION The patient was a 45-year-old woman who had undergone breast reconstruction after breast cancer surgery of the right breast 8 years previously. The patient presented with a mass and skin rash inside the inframammary area, and we suspected a damaged silicone breast implant (SBI) or chest wall recurrence. We examined the mass by a core needle biopsy and made a pathological diagnosis of BIA-ALCL. Imaging findings suggested internal thoracic lymph node swelling and lymphoma infiltration beyond the capsule but no metastatic lesions (cStage III). After en bloc resection of the SBI and lymphoma, adjuvant systemic therapy was performed. CONCLUSION We encountered the third case of BIA-ALCL in Japan. This was a case with clinically advanced stage of disease; however, the BIA-ALCL was found to be in remission.
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Affiliation(s)
- Wakako Tajiri
- Department of Breast Oncology, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Ryo Shimamoto
- Department of Plastic Surgery, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Yutaka Koga
- Department of Pathology, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Junji Kawasaki
- Department of Breast Oncology, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Makiko Higuchi
- Department of Hematology and Cell Therapy, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Yoshiaki Nakamura
- Department of Breast Oncology, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Yumiko Koi
- Department of Breast Oncology, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Chinami Koga
- Department of Breast Oncology, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Hideki Ijichi
- Department of Breast Oncology, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Ilseung Choi
- Department of Hematology and Cell Therapy, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Youko Suehiro
- Department of Hematology and Cell Therapy, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Kenichi Taguchi
- Department of Pathology, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Eriko Tokunaga
- Department of Breast Oncology, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan.
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Swanson E. The Risk of BIA-ALCL is Categorically Greater for Textured Breast Implants. Aesthetic Plast Surg 2024:10.1007/s00266-024-04170-3. [PMID: 38849550 DOI: 10.1007/s00266-024-04170-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 05/30/2024] [Indexed: 06/09/2024]
Affiliation(s)
- Eric Swanson
- Swanson Center, 11413 Ash St, Leawood, KS, 66211, USA.
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Chen JJ, Tokumori FC, Del Guzzo C, Kim J, Ruan J. Update on T-Cell Lymphoma Epidemiology. Curr Hematol Malig Rep 2024; 19:93-103. [PMID: 38451372 DOI: 10.1007/s11899-024-00727-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE OF REVIEW T-cell lymphomas (TCLs) are a group of rare subtypes of non-Hodgkin lymphoma derived from mature T-lymphocytes. Recent updates in lymphoma classification based on the cell-of-origin pathogenesis have shed new light on TCL epidemiology and outcomes. Contemporary regional consortia and international studies, including those conducted recently in Asia and South America, have provided an updated delineation of the major subtypes across various global regions. RECENT FINDINGS Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), remains the most common subtype globally except in Asia, where extra-nodal NK-T cell lymphoma (ENKTL) has emerged as the most prevalent. Angioimmunoblastic T-cell lymphoma (AITL) is the second most common subtype globally except in South America where its incidence falls behind adult T-cell leukemia/lymphoma (ATLL) and ENKTL. ALK-negative anaplastic large cell lymphoma (ALCL) has been recognized as the second most common subtype in some parts of South America. Studies on the newly classified breast implant-associated ALCL (BIA-ALCL) are beginning to reveal its distribution and risk factors. Deciphering the epidemiology of TCLs is a challenging endeavor due to the rarity of these entities and ongoing refinement in classification. Collaborative efforts on prospective registries based on the most current WHO classifications will help capture the true epidemiology of TCL subtypes to better focus resources for diagnostic, prognostic, and therapeutic efforts.
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MESH Headings
- Humans
- Lymphoma, T-Cell/epidemiology
- Lymphoma, T-Cell/diagnosis
- Lymphoma, T-Cell/therapy
- Lymphoma, T-Cell/pathology
- Incidence
- Lymphoma, T-Cell, Peripheral/epidemiology
- Lymphoma, T-Cell, Peripheral/therapy
- Lymphoma, T-Cell, Peripheral/diagnosis
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Affiliation(s)
- Jane J Chen
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Franco Castillo Tokumori
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10065, USA
| | | | - Jeanyoung Kim
- Division of Dermatology, Weill Cornell Medicine, New York, NY, USA
| | - Jia Ruan
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10065, USA.
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Karakas E, Ayhan MS, Karasu O, Kocak CO, Yalinay M. In Vivo Comparison of the Efficacy and Duration of Local Antibiotics on Smooth, Textured and Polyurethane Implant Surfaces. Aesthetic Plast Surg 2024:10.1007/s00266-024-04090-2. [PMID: 38806833 DOI: 10.1007/s00266-024-04090-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/15/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Capsular contracture is one of the most common complications after breast surgery involving silicone implants. The most likely cause of this condition is biofilm formation. In this study, the efficacy of local antibiotherapy against biofilm formation on implant surfaces was investigated. METHODS Thirty-six rats were divided into six groups. Three pockets were created on the dorsum of each rat, and 1 × 2 cm implant surface samples from smooth, polyurethane and textured implants were randomly placed into pockets. All samples were inoculated with staphylococcus epidermidis. In groups 1-2-3, inoculated samples were placed into the pockets and removed after 1, 6 and 24 h, respectively. In groups 4-5-6, inoculated samples immersed with rifamycin were placed and removed after 1, 6 and 24 h, respectively. Bacterial load was measured with plate count method. RESULTS Bacterial load was lower in groups 4-5-6 than in groups 1-2-3 (p < 0.05). In groups 4-5-6, bacterial load was lower for polyurethane than for textured surfaces at all time points (1, 6 and 24 h; p < 0.05). Again, in groups 4-5-6, bacterial load was lower for smooth than for textured surfaces at 24 h (p < 0.05). In groups 4-5-6, bacterial load was lower for polyurethane than for smooth surfaces at all time points, but difference was not statistically significant (1, 6 and 24 h; p < 0.05). CONCLUSION The results suggest that local antibiotic therapy was effective in reducing the bacterial load on all surfaces. The effectiveness of local rifamycin on the polyurethane surface was higher, and the duration of activity was longer than other surfaces. 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)
- Ebubekir Karakas
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - M Suhan Ayhan
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Oguzhan Karasu
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ceren Ozkul Kocak
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Meltem Yalinay
- Department of Medical Microbiology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Vorstenbosch J, Ghione P, Plitas G, Horwitz S, Kim M, Cordeiro P, Nelson J, McCarthy C. Surgical Management and Long-Term Outcomes of BIA-ALCL: A Multidisciplinary Approach. Ann Surg Oncol 2024; 31:2032-2040. [PMID: 38102324 DOI: 10.1245/s10434-023-14636-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/06/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a subtype of ALCL that arises as a seroma or a mass in the capsule surrounding textured breast implants. However, collections of cases usually come from large groups of institutions or countries, with different approaches regarding surgery and treatment. Here we describe a cohort of 18 cases undergoing implant removal and capsulectomy followed at Memorial Sloan Kettering Cancer Center (MSKCC). PATIENTS AND METHODS We retrospectively analyzed all the cases of women with breast implants undergoing implant removal and capsulectomy for BIA-ALCL at MSKCC from January 2011 to June 2020. RESULTS Median age at diagnosis was 57 (range 35-77) years following a median implant exposure of 11 (range 7-33) years. All known implants were macrotextured with the proprietary Biocell macrotexturing pattern from salt-loss technique. A total of 16 patients (89%) had implants placed for breast cancer reconstruction. Patients presented with clinically evident effusion in 78% of cases and a mass in 17% of cases, and 83% of patients presented with stage 1 BIA-ALCL. Patients were followed for a median of 43.4 months (SD 45 months) after diagnosis. There were no cases of recurrent ALCL. All patients remain disease free and no patients died of ALCL. CONCLUSIONS In this cohort of patients with BIA-ALCL surgically treated and followed at a single institution, we confirm the importance of adequate surgery (bilateral implant removal and complete capsulectomy) in patients presenting with seroma-confined disease. This dataset reinforces high rates of progression-free and overall survival when diagnosis is identified and treatment performed in those with limited-stage disease.
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Affiliation(s)
| | - Paola Ghione
- Lymphoma Section, Department of Medicine, Roswell Park Comprehensive Cancer Centre, Buffalo, NY, USA
| | - George Plitas
- Breast Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Steven Horwitz
- Hematology and Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Minji Kim
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter Cordeiro
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Colleen McCarthy
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Shoham G, Haran O, Singolda R, Madah E, Magen A, Golan O, Menes T, Arad E, Barnea Y. Our Experience in Diagnosing and Treating Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). J Clin Med 2024; 13:366. [PMID: 38256500 PMCID: PMC10816524 DOI: 10.3390/jcm13020366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon T-cell lymphoma detected in association with textured implants. It presents as a fluid accumulation around the implant, usually years after the implantation. We present our experience in diagnosing and treating four patients with BIA-ALCL, each widely differing from the other. Data on patients' surgical history, relevant medical information, and findings on pathological slides were retrieved from their medical charts and retrospectively reviewed. Each of the four patients was diagnosed with BIA-ALCL, one after breast augmentation, one after breast reconstruction with an implant, one after breast reconstruction with a latissimus dorsi flap and implant, and the fourth after the removal of breast implants. The cases were presented to a multidisciplinary team and subsequently underwent surgery. All four are currently free of tumors, as established by a negative follow-up via positron emission tomography-computed tomography. Although the incidence of BIA-ALCL is rare, these cases emphasize the need to rule out the diagnosis of BIA-ALCL in patients with textured implants or a history of implanted textured devices who present with symptoms such as late seroma or peri-implant mass. This pathology is typically indolent and slow-growing and heightened awareness for an early diagnosis could lead to quicker intervention and enhanced patient management.
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Affiliation(s)
- Gon Shoham
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Oriana Haran
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Roei Singolda
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ehab Madah
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ada Magen
- Breast Health Center, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Orit Golan
- Breast Imaging Center, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Tehillah Menes
- Meirav Breast Center, Sheba Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Hashomer 5262000, Israel
| | - Ehud Arad
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yoav Barnea
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Swanson E. Reply: Comment on BIA-ALCL: Comparing the Risk Profiles of Smooth and Textured Breast Implants. Aesthetic Plast Surg 2024; 48:19-22. [PMID: 37308573 PMCID: PMC10853077 DOI: 10.1007/s00266-023-03426-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/20/2023] [Indexed: 06/14/2023]
Abstract
Level of Evidence V 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)
- Eric Swanson
- Swanson Center, 11413 Ash St, Leawood, KS, 66211, USA.
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Santanelli di Pompeo F, Clemens MW, Paolini G, Firmani G, Panagiotakos D, Sorotos M. Epidemiology of Breast Implant-Associated Anaplastic Large Cell Lymphoma in the United States: A Systematic Review. Aesthet Surg J 2023; 44:NP32-NP40. [PMID: 37616552 DOI: 10.1093/asj/sjad279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/15/2023] [Accepted: 08/23/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Although textured implants represent fewer than 10% of implants used in the United States, the country reports the highest incidence of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). OBJECTIVES The aim of this study was to perform a systematic literature review on US-based epidemiology to update knowledge on BIA-ALCL in the United States. METHODS Publications on US BIA-ALCL epidemiology were searched between September 2022 and March 2023 on MEDLINE (National Institutes of Health; Bethesda, MD), Embase (Elsevier, Amsterdam, the Netherlands), Web of Science (Clarivate, London, UK), and SCOPUS (Elsevier, Amsterdam, the Netherlands). The US numerator was obtained by averaging the FDA MAUDE database and the PSF PROFILE registry, while the denominator was estimated from chest X-rays, and included female transgender individuals. Prevalence and risk were assessed accordingly, but the incidence rate (IR) could not be updated due to the lack of available follow-up data. RESULTS Out of 987 identified manuscripts, 10 were included. The US prevalence of BIA-ALCL in the literature ranged from 1:300 to 1:500,000 and the IR from 4.5 per 10,000 to 31.1 per 100 million persons per year. A mean value of 453.5 BIA-ALCL cases was calculated. From a denominator of 4,264,618 individuals, which includes all breast implant surfaces, we calculated 414,521 individuals with textured implants, indicating a textured prevalence of 109.4 cases per 100,000 individuals and a risk of 1:913. CONCLUSIONS BIA-ALCL IR, prevalence, and risk has increased when calculated exclusively for patients with textured devices. Although US macrotextured implants were recalled by the FDA, these findings may influence the surveillance of existing patients and the use of macrotextured implants in other parts of the world where they remain widespread. LEVEL OF EVIDENCE: 4
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Ogino S, Yamada A, Nakano T, Lee S, Yamanaka H, Tsuge I, Sowa Y, Sakamoto M, Kyoko F, Kambe Y, Kato Y, Arata J, Yamauchi K, Yamaoka T, Morimoto N. Long term observation of de novo adipogenesis using novel bioabsorbable implants with larger size in a porcine model. Regen Ther 2023; 24:324-331. [PMID: 37649673 PMCID: PMC10463193 DOI: 10.1016/j.reth.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/27/2023] [Accepted: 08/13/2023] [Indexed: 09/01/2023] Open
Abstract
Introduction The regeneration of adipose tissue in patients after breast cancer surgery would be desirable without the use of growth factors or cells to avoid potential recurrence and metastasis. We reported that prolate spheroidal-shaped poly-L-lactic acid (PLLA) mesh implants of approximately 18-mm polar diameter and 7.5-mm greatest equatorial diameter containing collagen sponge (CS) would be replaced by regenerated adipose tissue after implantation, thereby suggesting an innovative method for breast reconstruction. Our study aimed to evaluate the adipose tissue regeneration ability of implant aggregates in a porcine model. Methods We prepared implant aggregates consisting of thirty PLLA mesh implants containing CS packed in a woven poly (glycolic acid) bag. The implant aggregates were inserted under the mammary glands in the porcine abdomen for a year. Single and double groups were classified by inserting either one or two implant aggregates on each side of the abdomen, respectively. Results In both groups, the volume of the implant aggregates decreased over time, and the formation of adipose tissue peaked between 6 and 9 months. Histologically, the formation of adipose tissue was confirmed in the area that was in contact with native adipose tissue. Conclusions Our implant aggregates could induce the autologous adipose tissue after long term implantation in vivo, without the use of any growth factor or cell treatment, presenting a potential novel method of breast reconstruction.
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Affiliation(s)
- Shuichi Ogino
- Department of Plastic and Reconstructive Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Atsushi Yamada
- Department of Research and Development for Innovative Medical Devices and Systems, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Takashi Nakano
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyou-ku, Kyoto 606-8507, Japan
| | - Sunghee Lee
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyou-ku, Kyoto 606-8507, Japan
| | - Hiroki Yamanaka
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyou-ku, Kyoto 606-8507, Japan
| | - Itaru Tsuge
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyou-ku, Kyoto 606-8507, Japan
| | - Yoshihiro Sowa
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyou-ku, Kyoto 606-8507, Japan
| | - Michiharu Sakamoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyou-ku, Kyoto 606-8507, Japan
| | - Fukazawa Kyoko
- Department of Biomedical Engineering, National Cerebral and Cardiovascular Center Research Institute, 6-1 Kishibe Shin-machi, Suita, Osaka 564-8565, Japan
| | - Yusuke Kambe
- Department of Biomedical Engineering, National Cerebral and Cardiovascular Center Research Institute, 6-1 Kishibe Shin-machi, Suita, Osaka 564-8565, Japan
| | - Yuki Kato
- Gunze QOL Research Center Laboratory, 1 Zeze, Aono-cho, Ayabe, Kyoto 623-0051, Japan
| | - Jun Arata
- Department of Plastic and Reconstructive Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Koji Yamauchi
- Gunze QOL Research Center Laboratory, 1 Zeze, Aono-cho, Ayabe, Kyoto 623-0051, Japan
| | - Tetsuji Yamaoka
- Department of Biomedical Engineering, National Cerebral and Cardiovascular Center Research Institute, 6-1 Kishibe Shin-machi, Suita, Osaka 564-8565, Japan
| | - Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyou-ku, Kyoto 606-8507, Japan
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Swanson E. Breast Implant-Associated Anaplastic Large-Cell Lymphoma: Finding Fault Comes Full Circle. Ann Plast Surg 2023; 91:634-637. [PMID: 37651688 DOI: 10.1097/sap.0000000000003684] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Eric Swanson
- Dr Swanson is a plastic surgeon in private practice in Leawood, Kansas
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11
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Chetlen A, Niell BL, Brown A, Baskies AM, Battaglia T, Chen A, Jochelson MS, Klein KA, Malak SF, Mehta TS, Sinha I, Tuscano DS, Ulaner GA, Slanetz PJ. ACR Appropriateness Criteria® Breast Implant Evaluation: 2023 Update. J Am Coll Radiol 2023; 20:S329-S350. [PMID: 38040459 DOI: 10.1016/j.jacr.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
This document discusses the appropriate initial imaging in both asymptomatic and symptomatic patients with breast implants. For asymptomatic patients with saline implants, no imaging is recommended. If concern for rupture exists, ultrasound is usually appropriate though saline rupture is often clinically evident. The FDA recently recommended patients have an initial ultrasound or MRI examination 5 to 6 years after initial silicone implant surgery and then every 2 to 3 years thereafter. In a patient with unexplained axillary adenopathy with current or prior silicone breast implants, ultrasound and/or mammography are usually appropriate, depending on age. In a patient with concern for silicone implant rupture, ultrasound or MRI without contrast is usually appropriate. In the setting of a patient with breast implants and possible implant-associated anaplastic large cell lymphoma, ultrasound is usually appropriate as the initial imaging. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Alison Chetlen
- Penn State Health Hershey Medical Center, Hershey, Pennsylvania.
| | - Bethany L Niell
- Panel Chair, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Ann Brown
- Panel Vice-Chair, University of Cincinnati, Cincinnati, Ohio
| | - Arnold M Baskies
- Virtua Willingboro Hospital, Willingboro, New Jersey; American College of Surgeons
| | - Tracy Battaglia
- Boston University Schools of Medicine and Public Health, Boston, Massachusetts, Primary care physician
| | - Andrew Chen
- University of Connecticut School of Medicine, Farmington, Connecticut; American Society of Plastic Surgeons
| | | | | | | | - Tejas S Mehta
- UMass Memorial Medical Center/UMass Chan Medical School, Worcester, Massachusetts
| | - Indranil Sinha
- Harvard Medical School, Boston, Massachusetts; American Geriatrics Society
| | | | - Gary A Ulaner
- Hoag Family Cancer Institute, Newport Beach, California, and University of Southern California, Los Angeles, California; Commission on Nuclear Medicine and Molecular Imaging
| | - Priscilla J Slanetz
- Specialty Chair, Boston University School of Medicine, Boston, Massachusetts
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12
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Berry MG, Stanek JJ. The Double Capsule Phenomenon in a Case Series and its Relationship with the Macro-Textured Breast Implant. Aesthetic Plast Surg 2023; 47:1725-1730. [PMID: 36443419 PMCID: PMC9707171 DOI: 10.1007/s00266-022-03182-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/05/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Silicone breast augmentation remains one of the most common aesthetic surgery procedures, and 2022 marks the 60th anniversary of the first case. Recent studies suggest a link between double capsule (DC) formation and macro-textured devices. METHODS Between 2010 and 2015, 268 aesthetic patients underwent bilateral mammary prosthesis exchange for indications including PIP exchange, adverse capsular contracture and ultrasonographic evidence of rupture. All surgery, in the form of implant exchange and capsulectomy, was undertaken by the senior author using standard techniques. A retrospective review was undertaken, and data analysed with descriptive statistics and Fisher's exact and Mann-Whitney U tests. RESULTS Of 268 patients identified, 40 (14.9%) showed some degree of capsular duplication and bilateral involvement was marginally more common (52.5%). Two macroscopic patterns of duplication were observed: complete and subtotal. Complete DCs correlated with a clinical triad of extreme firmness, mobility and minimal-to-no pain. Whilst a wide range of manufacturers was represented, macro-textured devices were associated with the highest DC prevalence (58.3% vs. 5.6%) (Fisher's exact test p < 0.00001). Patients with DC had been implanted for less than half the time, median 52 versus. 120 months (p = 0.0003) of those without. DISCUSSION An elevated prevalence of duplicate capsules in macro-textured prostheses is reconfirmed in addition to a novel symptom constellation that may assist with clinical diagnosis. Our study reinforces the aetiopathogenic influence of the elastomer in DC formation and reports DC for the first time in non-macrotextured implants. Single-surgeon cohort of 268 consecutive patients with 532 implants Statistically significant association of macro-textured devices with DC Statistically significant reduced duration of implantation of macro-textured devices First report of DC in non-macro-textured devices LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Miles G Berry
- Surgical Aesthetics, Flat 19 Milford House, 7 Queen Anne Street, London, W1G 9HN, UK.
| | - Jan J Stanek
- Surgical Aesthetics, Flat 19 Milford House, 7 Queen Anne Street, London, W1G 9HN, UK
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13
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Rosenberg K, McGillen P, Zanfagnin V, Lee S, Janaki N, Raicu A, Jayachandran P, Bian S, Yenikomshian H, Sener SF. Invasive squamous cell carcinoma of the breast associated with breast augmentation implant capsule. J Surg Oncol 2023; 128:495-501. [PMID: 37260104 DOI: 10.1002/jso.27364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 06/02/2023]
Abstract
Primary squamous cell carcinoma (SCC) of the breast is rare, representing less than 0.1% of all breast cancers. To date, there have been 20 reported cases of SCC associated with breast augmentation, usually in patients with long-standing implants. A patient is reported here with primary squamous carcinoma of the breast associated with textured saline implants. Due to the paucity of cases, there is limited information on the incidence and management of implant-associated SCC of the breast.
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Affiliation(s)
- Katherine Rosenberg
- Departments of Radiology, and the Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
- Los Angeles General Medical Center (formerly LAC), Los Angeles, California, USA
| | - Patrick McGillen
- Los Angeles General Medical Center (formerly LAC), Los Angeles, California, USA
- Keck School of Medicine of USC, Surgery, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Valentina Zanfagnin
- Los Angeles General Medical Center (formerly LAC), Los Angeles, California, USA
- Keck School of Medicine of USC, Pathology, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Sandy Lee
- Departments of Radiology, and the Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
- Los Angeles General Medical Center (formerly LAC), Los Angeles, California, USA
| | - Nafiseh Janaki
- Los Angeles General Medical Center (formerly LAC), Los Angeles, California, USA
- Keck School of Medicine of USC, Pathology, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Andreea Raicu
- Los Angeles General Medical Center (formerly LAC), Los Angeles, California, USA
- Keck School of Medicine of USC, Surgery, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Priya Jayachandran
- Los Angeles General Medical Center (formerly LAC), Los Angeles, California, USA
- Keck School of Medicine of USC, Medicine, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Shelly Bian
- Los Angeles General Medical Center (formerly LAC), Los Angeles, California, USA
- Keck School of Medicine of USC, Radiation Oncology, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Haig Yenikomshian
- Los Angeles General Medical Center (formerly LAC), Los Angeles, California, USA
- Keck School of Medicine of USC, Surgery, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Stephen F Sener
- Los Angeles General Medical Center (formerly LAC), Los Angeles, California, USA
- Keck School of Medicine of USC, Surgery, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
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14
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Keane GC, Keane AM, Diederich R, Kennard K, Duncavage EJ, Myckatyn TM. The evaluation of the delayed swollen breast in patients with a history of breast implants. Front Oncol 2023; 13:1174173. [PMID: 37476374 PMCID: PMC10354431 DOI: 10.3389/fonc.2023.1174173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023] Open
Abstract
Breast implants, whether placed for reconstructive or cosmetic purposes, are rarely lifetime devices. Rupture, resulting from compromised implant shell integrity, and capsular contracture caused by constriction of the specialized scar tissue that normally forms around breast implants, have long been recognized, and remain the leading causes of implant failure. It is apparent, however, that women with breast implants may also experience delayed breast swelling due to a range of etiologic factors. While a majority of delayed seromas associated with breast implants have a benign etiology, this presentation cannot be ignored without an adequate workup as malignancies such as breast implant associated anaplastic large cell lymphoma (BIA-ALCL), breast implant associated diffuse large B-cell lymphoma (BIA-DLBCL), and breast implant associated squamous cell carcinoma (BIA-SCC) can have a similar clinical presentation. Since these malignancies occur with sufficient frequency, and with sometimes lethal consequences, their existence must be recognized, and an appropriate diagnostic approach implemented. A multidisciplinary team that involves a plastic surgeon, radiologist, pathologist, and, as required, surgical and medical oncologists can expedite judicious care. Herein we review and further characterize conditions that can lead to delayed swelling around breast implants.
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Affiliation(s)
- Grace C. Keane
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO, United States
| | - Alexandra M. Keane
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO, United States
| | - Ryan Diederich
- MidAmerica Plastic Surgery, Glen Carbon, IL, United States
| | - Kaitlyn Kennard
- Division of Surgical Oncology, Washington University School of Medicine, Saint Louis, MO, United States
| | - Eric J. Duncavage
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, United States
| | - Terence M. Myckatyn
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO, United States
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15
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Kim YH, Park DW, Song KY, Lim HG, Jeong JP, Kim JH. Use of High-Resolution Ultrasound in Characterizing the Surface Topography of a Breast Implant. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1092. [PMID: 37374297 DOI: 10.3390/medicina59061092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/19/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: With the emergence of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), it has become necessary to identify the implant shell type patients have received. Therefore, an immediate, reliable method for identifying a breast implant shell type is essential. Evidence-based research and applying a real-world technique that identifies the surface topographic information of the inserted breast implants, without surgery, has become of paramount importance for breast implant physicians. Methods and Materials: A review of the medical records of 1901 patients who received 3802 breast implants and subsequently received an ultrasound-assisted examination was performed. All patients received not only a breast cancer examination but also a high-resolution ultrasonography (HRUS) assisted examination of the device at a single center between 31 August 2017 and 31 December 2022. Results: Most patients had breast implants within 10 years (77.7%) of the examination. Of the 3802 implants screened, 2034 (53.5%) were identified with macro-textured shell topography in ultrasonography. A macrotextured shell type implant was used in 53.5% of cases and a smooth type in 42.7% of cases. Seventy-three (1.9%) breast implant shell types could not be identified due to ruptures. However, 250 breast implant shell types could be identified despite rupture cases (6.5%). Conclusions: HRUS was found to be a useful and reliable image modality for identifying various surface shell types of breast implants. The shell type information would be helpful to patients who lack information about their breast implants and are concerned about BIA-ALCL.
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Affiliation(s)
- Yang-Hee Kim
- Department of Surgery, Kangwon National University, Chuncheon 24289, Republic of Korea
| | | | - Keun-Yeong Song
- Department of Breast Surgery, Gwangju Suwan Hospital, Gwangju 62247, Republic of Korea
| | - Hyung-Guhn Lim
- Department of Radiology, Gwangju Suwan Hospital, Gwangju 62247, Republic of Korea
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16
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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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17
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Hecker A, Giese B, Pignet AL, Schellnegger M, Kamolz LP, Lumenta DB. Textured vs. Smooth Breast Implants Using the Jones Criteria-What Is the Currently Available Evidence for BIA-ALCL?: A Systematic Review. J Pers Med 2023; 13:jpm13050816. [PMID: 37240986 DOI: 10.3390/jpm13050816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/01/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Breast-Implant-Associated Anaplastic Large-Cell Lymphoma (BIA-ALCL) is a rare low-incidence type of T-cell non-Hodgkin lymphoma, arising in the capsule around breast implants, and predominantly associated with the use of macro-textured breast implants. The purpose of this study was to use an evidence-based approach to systematically identify clinical studies comparing smooth and textured breast implants in women with regard to the risk of developing BIA-ALCL. METHODS A literature search in PubMed in April 2023 and the article reference list of the French National Agency of Medicine and Health Products decision from 2019 were screened for applicable studies. Only clinical studies where the Jones surface classification could be applied (required information: breast implant manufacturer) for comparison of smooth and textured breast implants were considered. RESULTS From a total of 224 studies, no articles were included due to the lack of fit to the strict inclusion criteria. CONCLUSIONS Based on the scanned and included literature, implant surface types in relation to the incidence of BIA-ALCL were not evaluated in clinical studies and data from evidence-based clinical sources plays a minor to no role in this context. An international database that combines breast implant-related data from (national, opt-out) medical device registries is, therefore, the best available option to obtain relevant long-term breast implant surveillance data on BIA-ALCL.
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Affiliation(s)
- Andrzej Hecker
- Research Unit for Digital Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
- COREMED-Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria
| | | | - Anna-Lisa Pignet
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
- COREMED-Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria
| | - Marlies Schellnegger
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
- COREMED-Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
- COREMED-Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria
| | - David Benjamin Lumenta
- Research Unit for Digital Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
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18
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Mesa F, Bernal Arrubla J, Javier Gallón L, Matute Turizo G, Caicedo Ruiz DM. Breast Implant-associated Anaplastic Large Cell Lymphoma after Breast Reconstruction for Breast Cancer. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4911. [PMID: 37038413 PMCID: PMC10082277 DOI: 10.1097/gox.0000000000004911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/14/2023] [Indexed: 04/12/2023]
Abstract
A patient initially operated on for aesthetic breast augmentation had a round-textured silicone gel prosthesis, Poly Implants Prothèse, placed in a subglandular plane. The patient developed a bilateral capsular contracture, and 4 years later, underwent a complete bilateral capsulectomy with an exchange of Mentor 215 cm3 textured cohesive silicone-gel ultra-high profile breast implants in the same subglandular plane. One year later, the patient developed cancer in the right breast, so it was decided to perform a bilateral mastectomy and reconstruction with 265 cm3 (left) and 310 cm3 (right) Natrelle (Allergan) round-textured silicone-gel implants in a submuscular plane. Seven years after the last surgery, the patient developed a seroma in the left breast (breast opposite to the one that developed the cancer), and seroma studies reported a CD30-positive anaplastic large cell lymphoma associated with the breast prosthesis. Therefore, bilateral capsulectomy and explantation of both implants with breast reconstruction with autologous tissue were performed.
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Affiliation(s)
- Felipe Mesa
- From the IQ Interquirofanos, Fundación Colombiana de Cancerología–Clínica Vida, Plastic Surgery CES University, Medellín, Colombia
| | | | - Luis Javier Gallón
- From the IQ Interquirofanos, Fundación Colombiana de Cancerología–Clínica Vida, Plastic Surgery CES University, Medellín, Colombia
- Fundación Colombiana de Cancerología–Clinica Vida, CES University, Medellin, Colombia
| | - Gustavo Matute Turizo
- Laboratorio LA PACI y Patología Integral, CES University, Cartagena and Pontificia Bolivariana, Medellin, Colombia
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19
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Lee JH, Jang JH, Min KH. A Comparison of Smooth and Microtextured Breast Implants in Breast Augmentation: A Retrospective Study. Arch Plast Surg 2023; 50:160-165. [PMID: 36999152 PMCID: PMC10049833 DOI: 10.1055/s-0042-1760405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 11/30/2022] [Indexed: 03/30/2023] Open
Abstract
Background
The number of cosmetic and reconstructive surgeries that use breast implants is increasing in Korea. Recently, it has been reported that breast implant-associated anaplastic large-cell lymphoma is related to textured breast implants, and interest in classification according to the texture of breast implants is increasing. However, there is currently no clear and unified classification. In particular, the definition of “microtextured” is highly varied. In this study, we retrospectively investigated and analyzed the clinical outcomes of smooth and microtextured breast implants.
Methods
A retrospective chart review of all patients who underwent breast augmentation surgery with smooth and microtextured silicone gel implants between January 2016 and July 2020 was performed. We retrospectively analyzed implant manufacturer, age, body mass index (BMI), smoking status, incision location, implant size, follow-up period, complications, and reoperation rate.
Results
A total of 266 patients underwent breast augmentation surgery, of which 181 used smooth silicone gel implants and 85 used microtextured silicone gel implants. Age, BMI, smoking status, implant size, and follow-up period were not significantly different between the two groups. Similarly, complications and reoperation rates were not significantly different between the two groups.
Conclusion
It is important to provide information regarding the clinical risks and benefits of breast implants to surgeons and patients through a clear and unified classification according to the texture of the breast implant.
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Affiliation(s)
- Joo Hyuck Lee
- KIES-U Plastic Surgery Clinic, Seoul, Republic of Korea
| | - Jae Hyuk Jang
- Department of Plastic and Reconstructive Surgery, Nowon Eulji Medical Center, School of Medicine, Eulji University, Seoul, Republic of Korea
| | - Kyung Hee Min
- Department of Plastic and Reconstructive Surgery, Nowon Eulji Medical Center, School of Medicine, Eulji University, Seoul, Republic of Korea
- Address for correspondence Kyung Hee Min, MD, PhD Department of Plastic and Reconstructive SurgeryNowon Eulji Medical Center, School of Medicine, Eulji University, 68, Hangeulbiseok-ro, Nowon-gu, Seoul 01830Republic of Korea
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20
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Williams DF. The plasticity of biocompatibility. Biomaterials 2023; 296:122077. [PMID: 36907003 DOI: 10.1016/j.biomaterials.2023.122077] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/19/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
Biocompatibility concerns the phenomena that occur within the interactions between biomaterials and human patients, which ultimately control the performance of many facets of medical technology. It involves aspects of materials science, many different forms of engineering and nanotechnology, chemistry, biophysics, molecular and cellular biology, immunology, pathology and a myriad of clinical applications. It is not surprising that an overarching framework of mechanisms of biocompatibility has been difficult to elucidate and validate. This essay discusses one fundamental reason for this; we have tended to consider biocompatibility pathways as essentially linear sequences of events which follow well-understood processes of materials science and biology. The reality, however, is that the pathways may involve a great deal of plasticity, in which many additional idiosyncratic factors, including those of genetic, epigenetic and viral origin, exert influence, as do complex mechanical, physical and pharmacological variables. Plasticity is an inherent core feature of the performance of synthetic materials; here we follow the more recent biological applications of plasticity concepts into the sphere of biocompatibility pathways. A straightforward linear pathway may result in successful outcomes for many patients; we may describe this in terms of classic biocompatibility pathways. In other situations, which usually command much more attention because of their unsuccessful outcomes, these plasticity-driven processes follow alternative biocompatibility pathways; often, the variability in outcomes with identical technologies is due to biological plasticity rather than material or device deficiency.
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Affiliation(s)
- David F Williams
- Wake Forest Institute of Regenerative Medicine, Winston-Salem, North Carolina, USA.
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21
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Breast Reconstruction after Breast Implant-Associated Anaplastic Large Cell Lymphoma Treatment: A Case Report and Literature Review. J Clin Med 2023; 12:jcm12051885. [PMID: 36902672 PMCID: PMC10003959 DOI: 10.3390/jcm12051885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a T-cell non-Hodgkin's lymphoma that occurs in patients with at least one prior textured breast implant. BIA-ALCL has a relatively good prognosis when treated promptly. However, data on the methods and timing of the reconstruction process are lacking. Herein, we report the first case of BIA-ALCL in Republic of Korea in a patient who underwent breast reconstruction using implants and an acellular dermal matrix (ADM). A 47-year-old female patient was diagnosed with BIA-ALCL stage IIA (T4N0M0) and underwent bilateral breast augmentation using textured breast implants. She then underwent removal of both breast implants, total bilateral capsulectomy, adjuvant chemotherapy, and radiotherapy. There was no evidence of recurrence at 28 months postoperatively; therefore, the patient wished to undergo breast reconstruction surgery. A smooth surface implant was used to consider the patient's desired breast volume and body mass index. The right breast was reconstructed with a smooth surface implant and an ADM in the prepectoral plane. Breast augmentation was performed on the left breast using a smooth surface implant. The patient was satisfied with the results and recovered fully with no complications.
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22
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Breast Surgery with Smooth Anatomical Implants with Fixation System: A Review of the World's Largest Series of Cases. Plast Reconstr Surg 2023; 151:207e-213e. [PMID: 36696306 DOI: 10.1097/prs.0000000000009829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Anatomical implants continue to be a particularly useful tool in breast surgery, offering an excellent result for certain indications. However, to ensure fixation and prevent rotation, traditional alternatives have medium to high surface roughness and have been controversial in recent years. METHODS A retrospective assessment of 122 prosthetic augmentation and reconstruction patients over a period of 5 years was conducted. Patients were treated with tabbed anatomical implants with a smooth surface and followed up for a period of 12 months. Demographics, complications, and patient satisfaction were captured. A subgroup of 101 patients were assessed with chest radiographs at 1-year follow-up. Technical recommendations are discussed. RESULTS Primary breast augmentation, revision augmentation, augmentation-mastopexy, and breast reconstruction were the main indications for surgery. All implants were inserted through an inframammary incision and placed in the subpectoral space using dual-plane techniques, except in one mastectomy case. Rotation of the implants was radiographically observed in only two cases of revision augmentation. None of the 122 patients developed capsular contracture, seroma, rupture, infection, hematoma, or malposition following breast surgery. CONCLUSIONS Smooth anatomical implants with a fixation system offer reliable and satisfactory results for patients with various diagnoses and indications. The tab system and the fixation technique are essential to provide long-term stability, which was verified by radiographs because of the radiopaque lines present in the device for that purpose. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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23
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Abdominoplasty and Breast Augmentation with Outpatient Cosmetic Deep Inferior Epigastric Perforator Flaps. Plast Reconstr Surg 2023; 151:234e-240e. [PMID: 36354968 DOI: 10.1097/prs.0000000000009836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The authors describe the use of deep inferior epigastric perforator (DIEP) flaps in outpatient cosmetic breast augmentation. METHODS The authors reviewed patients who had undergone cosmetic breast augmentation with DIEP flaps over a 12-month period. Any patient who desired breast augmentation, implant exchange, or augmentation mastopexy with concomitant abdominoplasty was considered a candidate for the procedure. All patients underwent an early recovery protocol including microfascial incisions to harvest the DIEP flaps and rib preservation in addition to early recovery after surgery protocols with intraoperative anesthetic blocks. RESULTS Eleven consecutive patients underwent bilateral cosmetic breast augmentation with DIEP flaps and mastopexy. Overall, all patients reported preoperative dissatisfaction with their abdomen and breasts. Microfascial incisions for single perforator abdominal flaps ( n = 17) averaged 1.7 cm (range, 1.3 to 2.4 cm) and flaps with multiple perforators ( n = 5) averaged 2.4 cm (range, 2 to 2.5 cm). Dissection of recipient internal mammary artery vessels was performed without disruption of the rib. No fascia or muscle tissue was taken during flap dissection. All patients had strong Doppler signals before discharge within 23 hours. No partial or total flap losses, major complications, or take-backs were reported. CONCLUSIONS Patients who desire abdominoplasty and augmentation are ideal candidates for this procedure. Breast augmentation with autologous tissue, particularly the DIEP flap, is an attractive option inherent to the additional abdominal tissue available to harvest. The early recovery protocol allows the surgeon to perform microsurgical breast reconstructions and augmentations in an outpatient setting, with excellent results and no total or partial flap losses, offsetting the high costs associated with the DIEP flap. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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24
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Xia Z, Han B, Wang L, Ning G, Guo Z, Zhang J, Yu B, Chen M, Zhang W, Wang K, Ma X. Breast implant-associated squamous cell carcinoma in a male patient: A case report and review of the medical literature. Front Surg 2023; 9:983611. [PMID: 36704519 PMCID: PMC9871623 DOI: 10.3389/fsurg.2022.983611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
Background Primary squamous cell carcinoma (SCC) of the breast is a rare tumor type. The diagnosis of this tumor type is more frequently made only after microscopy evaluation. Breast implant-associated SCC is rarer with medical literature review indicating only 18 cases reported in female individuals. Case presentation We reported an unusual case that a man found a 3-cm sized mass on his left breast at first, who had a implant surgery 18 years previously to reconstruct the deformed left breast, as related to the Poland's syndrome. More than 1 year after the mass was detected, the size of the mass gradually increased to 20 cm with swelling and severe pain, and the patient was admitted to our hospital. The patient underwent surgical excision of the tumor, followed by removal of the implant, complete capsulectomy, and sentinel lymph node biopsy. The microscopy evaluation demonstrated the tumor as moderately and poorly differentiated invasive SCC. Follow-up at 12 months after showed multiple metastases, including the skin of the chest, axillary lymph nodes and pleura. Conclusion Breast implant-associated SCC can occur in male patients. Therefore, it should be considered when the clinical manifestation or histopathological appearance is not typical of other breast neoplasms. Malignant transformation of normal epithelial cells takes about 18 years, after which rapid evolution follows leading to fast growth of the tumor.
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Affiliation(s)
- Zihuan Xia
- Department of Plastic Surgery, Nanjing Tongren Hospital, Southeast University, Nanjing, China
| | - Bing Han
- Department of Plastic Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Lei Wang
- Department of Plastic Surgery, Zhongda Hospital, Southeast University, Nanjing, China,Correspondence: Lei Wang Guansen Ning
| | - Guansen Ning
- Department of Plastic Surgery, Nanjing Tongren Hospital, Southeast University, Nanjing, China,Correspondence: Lei Wang Guansen Ning
| | - Zongke Guo
- Department of Plastic Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Jue Zhang
- Department of Plastic Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Bing Yu
- Department of Plastic Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Ming Chen
- Department of Plastic Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Wanxing Zhang
- Department of Plastic Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Ke Wang
- Department of Plastic Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Xiaojun Ma
- Department of Plastic Surgery, Nanjing Tongren Hospital, Southeast University, Nanjing, China
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Garnier L, Tourasse C, Frobert P, Vaucher R, Perez S, Delay E. [How to manage late periprosthetic fluid collections (seromas) in patients with breast implants?]. ANN CHIR PLAST ESTH 2023; 68:66-76. [PMID: 36266214 DOI: 10.1016/j.anplas.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/18/2022] [Accepted: 09/26/2022] [Indexed: 01/18/2023]
Abstract
The widespread use of silicone implants in reconstructive and aesthetic breast surgery led to an increase in the incidence of breast implant associated anaplastic large cell lymphoma, BIA-ALCL, mainly associated with the use of macro-textured breast implants. BIA-ALCL is a serious complication presenting clinically as a late onset periprosthetic seroma. Thus, its occurrence became an alarming sign feared by most plastic surgeons. Therefore, a good knowledge with respect to early diagnosis, subsequent workup, and treatment is crucial in the management of periprosthetic seroma. The diagnosis of late onset seroma is clinically evident. Although idiopathic seroma is the most common cause, BIA-ALCL should be always eliminated. A complete workup is usually necessary. An ultrasound performed by a radiologist specialized in breast imaging followed by an ultrasound guided puncture is imperative. Consequently, the cytological and the bacteriological analysis will orient us toward the etiology (infectious, neoplastic or mechanical). A standardized management of late periprosthetic seroma does not exist, with various factors are to be taken into consideration. These include the surgeon's experience, the diagnosis, and the medical institution facilities. Although idiopathic seroma is managed by a simple puncture and drainage, other causes may require a surgical procedure with implant removal, capsulotomies, and/or total capsulectomies.
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Affiliation(s)
- L Garnier
- Département de chirurgie plastique et reconstructrice, centre Léon Bérard, Lyon, France
| | - C Tourasse
- Service de radiologie, hôpital privé Jean Mermoz, Lyon, France
| | - P Frobert
- Département de chirurgie plastique et reconstructrice, centre Léon Bérard, Lyon, France
| | - R Vaucher
- Département de chirurgie plastique et reconstructrice, centre Léon Bérard, Lyon, France
| | - S Perez
- Département de chirurgie plastique et reconstructrice, centre Léon Bérard, Lyon, France
| | - E Delay
- Département de chirurgie plastique et reconstructrice, centre Léon Bérard, Lyon, France; Cabinet, 50, rue de la République, 69002 Lyon, France.
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26
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Silveira LDHJ, de Oliveira VS, Pinheiro RF. Breast implant-associated - Anaplastic Large Cell Lymphoma: a call for disease awareness. Hematol Transfus Cell Ther 2023; 45:124-126. [PMID: 34598910 PMCID: PMC9938461 DOI: 10.1016/j.htct.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 02/06/2023] Open
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Vorstenbosch J, Chu JJ, Ariyan CE, McCarthy CM, Disa JJ, Nelson JA. Clinical Implications and Management of Non-BIA-ALCL Breast Implant Capsular Pathology. Plast Reconstr Surg 2023; 151:20e-30e. [PMID: 36194076 PMCID: PMC9797444 DOI: 10.1097/prs.0000000000009780] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
SUMMARY The breast implant capsule is a dynamic structure that forms following the implantation of a device. Although normally benign, increased awareness of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) highlights that disease may arise from the capsule. BIA-ALCL presents as a late seroma or mass but explains few of the late seromas found in breast implant patients. To date, many of these seromas lack a clear cause and are often described as "idiopathic." Several benign and malignant breast implant capsular diseases can cause a late seroma or mass, including breast implant-associated squamous cell carcinoma. Similar to early reports of BIA-ALCL, these conditions are rare and largely limited to case reports or series. The purpose of this special topic is to present a narrative review highlighting capsular abnormalities that contribute to the formation of late seroma or mass in an attempt to broaden the differential diagnosis and help plastic surgeons identify the cause. Specifically, we review the presentation and management of BIA-ALCL, synovial metaplasia, capsular epithelialization, late hematoma, double capsule, breast cancer, squamous cell carcinoma, mesenchymal tumor, and B-cell lymphoma. Although rare, plastic surgeons should consider these capsular conditions as causes of late seromas and masses. Usually, these conditions may be diagnosed by following the National Comprehensive Cancer Network screening guidelines for BIA-ALCL. Thorough evaluation and workup of late seromas and masses may lead to improved characterization of these rare breast implant capsular conditions and improve our understanding of their pathophysiology and management.
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Affiliation(s)
- Joshua Vorstenbosch
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jacqueline J. Chu
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Charlotte E. Ariyan
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Colleen M. McCarthy
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph J. Disa
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonas A. Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Foroushani FT, Dzobo K, Khumalo NP, Mora VZ, de Mezerville R, Bayat A. Advances in surface modifications of the silicone breast implant and impact on its biocompatibility and biointegration. Biomater Res 2022; 26:80. [PMID: 36517896 PMCID: PMC9749192 DOI: 10.1186/s40824-022-00314-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/31/2022] [Indexed: 12/15/2022] Open
Abstract
Silicone breast implants are commonly used for cosmetic and oncologic surgical indications owing to their inertness and being nontoxic. However, complications including capsular contracture and anaplastic large cell lymphoma have been associated with certain breast implant surfaces over time. Novel implant surfaces and modifications of existing ones can directly impact cell-surface interactions and enhance biocompatibility and integration. The extent of foreign body response induced by breast implants influence implant success and integration into the body. This review highlights recent advances in breast implant surface technologies including modifications of implant surface topography and chemistry and effects on protein adsorption, and cell adhesion. A comprehensive online literature search was performed for relevant articles using the following keywords silicone breast implants, foreign body response, cell adhesion, protein adsorption, and cell-surface interaction. Properties of silicone breast implants impacting cell-material interactions including surface roughness, wettability, and stiffness, are discussed. Recent studies highlighting both silicone implant surface activation strategies and modifications to enhance biocompatibility in order to prevent capsular contracture formation and development of anaplastic large cell lymphoma are presented. Overall, breast implant surface modifications are being extensively investigated in order to improve implant biocompatibility to cater for increased demand for both cosmetic and oncologic surgeries.
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Affiliation(s)
- Fatemeh Tavakoli Foroushani
- Wound and Keloid Scarring Research Unit, Hair and Skin Research Laboratory, Division of Dermatology, Department of Medicine, The South African Medical Research Council, University of Cape Town, Cape Town, South Africa
| | - Kevin Dzobo
- Wound and Keloid Scarring Research Unit, Hair and Skin Research Laboratory, Division of Dermatology, Department of Medicine, The South African Medical Research Council, University of Cape Town, Cape Town, South Africa
| | - Nonhlanhla P Khumalo
- Wound and Keloid Scarring Research Unit, Hair and Skin Research Laboratory, Division of Dermatology, Department of Medicine, The South African Medical Research Council, University of Cape Town, Cape Town, South Africa
| | | | | | - Ardeshir Bayat
- Wound and Keloid Scarring Research Unit, Hair and Skin Research Laboratory, Division of Dermatology, Department of Medicine, The South African Medical Research Council, University of Cape Town, Cape Town, South Africa.
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29
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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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30
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Muacevic A, Adler JR. Current Understanding of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Cureus 2022; 14:e30516. [PMID: 36420249 PMCID: PMC9678239 DOI: 10.7759/cureus.30516] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/20/2022] [Indexed: 01/25/2023] Open
Abstract
Every year, breast implants are inserted worldwide for reconstructive or aesthetic reasons. Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rather uncommon type of T cell lymphoma that is positive for the CD30 biomarker. Despite being far more common than other primary breast lymphomas, BIA-ALCL has a very low incidence. Textured types of implants have been linked to almost all cases. The majority of patients have a favorable prognosis after the removal of implants and capsules. Nevertheless, the chance of a fatal outcome is higher with capsular invasion and tumor bulk. Although the exact cause of BIA-ALCL is unknown, it has been suggested that persistent infections or toxins related to the implants may play a role. Therefore, physicians must be aware of breast implants' rare but potentially significant side effects. Before surgery, patients with verified instances should be directed to a breast medical oncologist or lymphoma specialist for oncologic assessment. Total en-bloc capsulectomy, a surgical procedure that removes the implant and the surrounding capsule, is usually adequate. In other cases, a late diagnosis necessitates more invasive surgery and systemic therapies, which, while typically effective, have been linked to poor outcomes and even fatalities. Since it is a recently described entity and the "denominator" (i.e., the total number of breast implant procedures) is unknown, it is challenging to determine the risk of development. In this review, we hope to emphasize the elements of etiology, demography, clinical features, and current treatment approaches for BIA-ALCL. In doing so, we hope to increase the medical professional's knowledge of the recognition and treatment of BIA-ALCL.
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31
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A South African Breast Implant-Associated Anaplastic Large Cell Lymphoma: Clinical Presentation and Six-Year Follow-Up. Case Rep Oncol Med 2022; 2022:4162832. [PMID: 35685060 PMCID: PMC9173911 DOI: 10.1155/2022/4162832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/08/2022] [Accepted: 05/13/2022] [Indexed: 11/20/2022] Open
Abstract
Breast augmentation is the most common surgical procedure for women globally, with 1,795,551 cases performed in 2019. Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is highly uncommon, with 733 reported cases as of January 2020. In South Africa, there are less than 4000 breast augmentation surgeries annually. This case presents the first case report documentation of a South African woman diagnosed with BIA-ALCL. The patient was a 61-year-old woman who consulted the Breast Care Centre of Excellence in Johannesburg in 2015. She had a prior history of bilateral augmentation mammoplasty with subsequent implant exchange. The patient presented with periprosthetic fluid with a mass-like enhancement on the left breast. Aspiration of the mass-like fluid was positive for CD45, CD30, and CD68 and negative for CD20 and ALK-1, indicative of BIA-ALCL. Surgical treatment included bilateral explantation, complete capsulectomies, and bilateral mastopexy. Macroscopic examination of the left breast capsulectomy demonstrated fibrous connective tissue. The histological examination of the tumor showed extensive areas of broad coagulative necrosis with foamy histiocytes. Immunohistochemistry examination of this tumor showed CD3-, CD20-, and ALK-1-negative and CD30- and CD68-positive stains. PCR analysis for T-cell clonality showed monoclonal T-cell expansion. These findings confirm the presence of BIA-ALCL. The patient recovered well after surgery and did not require adjuvant therapy. A patient with a confirmed diagnosis of BIA-ALCL was successfully treated with explantation and complete capsulectomy. She was followed up regularly for six years, and the patient remains well and in remission.
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32
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Putative mechanobiological impact of surface texture on cell activity around soft-tissue implants undergoing micromotion. Biomech Model Mechanobiol 2022; 21:1117-1131. [PMID: 35534762 DOI: 10.1007/s10237-022-01578-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 03/25/2022] [Indexed: 11/02/2022]
Abstract
Recent reports of adverse health effects (e.g., capsular contracture, lymphoma) linked to the absence or presence of texture on soft-tissue implants (e.g., breast implants) suggest surface topography may have pathological impact(s). We propose that surface texture influences the transfer of displacements, experienced by an implant undergoing micromotion, to surrounding interfacial extracellular matrix, which in turn impacts the activity of the resident cells and is based on degree of tissue integration. We hypothesize that transfer of displacements due to micromotion promotes interstitial fluid movement that imposes hydrodynamic stresses (pressures, shear stresses) on cells residing in the interfacial tissues and impacts their activity. To address this, we developed a computer simulation to approximate hydrodynamic stresses in the interstitial environment of saturated poroelastic tissues (model soft-tissue implantation sites) generated from oscillatory implant micromotion as a function of the magnitude of translational displacement, direction of motion, degree of tissue integration, and surface roughness of the implant. Highly integrated implants were predicted to generate the highest fluid shear stresses within model tissues, with oscillatory fluid shear stresses up to 80 dyn/cm2 for a 20-μm displacement. Notably, application of oscillatory 80 dyn/cm2 shear stress to cultured human fibroblasts elicited cell death after 20 h compared to cells maintained under static conditions or exposed to 80 dyn/cm2 steady, unidirectional shear. These results indicate that oscillatory interstitial fluid stresses generated by micromotion of an integrated implant may influence the activity of the surrounding cells and play a role in the body's fibrotic response to textured soft-tissue implants.
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33
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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]
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34
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Yoo H, Park JU, Chang H. Comprehensive Evaluation of the Current Knowledge on Breast Implant Associated-Anaplastic Large Cell Lymphoma. Arch Plast Surg 2022; 49:141-149. [PMID: 35832665 PMCID: PMC9045542 DOI: 10.1055/s-0042-1744422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently spotlighted T-cell origin non-Hodgkin's lymphoma with an increasing incidence of over 800 cases and 33 deaths reported worldwide. Development of BIA-ALCL is likely a complex process involving many factors, such as the textured implant surface, bacterial biofilm growth, immune response, and patient genetics. As the incidence of BIA-ALCL is expected to increase, it is important for all surgeons and physicians to be aware of this disease entity and acquire thorough knowledge of current evidence-based guidelines and recommendations. Early detection, accurate diagnosis, and appropriate treatment are the foundations of current care.
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Affiliation(s)
- Hyokyung Yoo
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Ung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hak Chang
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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35
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Nestler JA, Kim JK, Goodreau AM, Mountziaris PM, McGuire KP. Invasive stage III breast implant-associated anaplastic large cell lymphoma successfully treated with incomplete resection. BMJ Case Rep 2022; 15:e246664. [PMID: 35379678 PMCID: PMC8981349 DOI: 10.1136/bcr-2021-246664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/04/2022] Open
Abstract
A woman with history of bilateral breast augmentation 15 years prior presented with right breast swelling, peri-implant effusion and a palpable inferomedial mass. Effusion aspiration demonstrated pleiomorphic cells consistent with breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Further diagnostic studies confirmed stage III disease with a 4.7 cm right breast mass and fluorodeoxyglucose uptake in an internal mammary chain lymph node. The patient underwent surgery with incomplete resection due to invasion of the chest wall followed by chemotherapy and radiation therapy. BIA-ALCL typically presents as an indolent effusion, however advanced disease carries a worse prognosis. This case highlights successful treatment without recurrence past the one-year mark as well as the need for multidisciplinary management when dealing with advanced disease.
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Affiliation(s)
- John A Nestler
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Jin Kyung Kim
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Adam M Goodreau
- Department of Plastic and Reconstructive Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Paschalia M Mountziaris
- Department of Plastic and Reconstructive Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Kandace P McGuire
- Department of Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA
- Massey Cancer Center, Virginia Commonwealth University Health System, Richmond, Virginia, USA
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36
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Mehta-Shah N, Ghione P. An Updated Approach and Understanding of Breast Implant-Associated Anaplastic Large Cell Lymphoma. J Natl Compr Canc Netw 2022; 20:309-315. [PMID: 35276670 DOI: 10.6004/jnccn.2022.7004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/13/2022] [Indexed: 11/17/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare subtype of T-cell non-Hodgkin lymphoma that is usually localized to the fluid and capsule surrounding a breast implant. There have only been <1,000 cases and 36 deaths reported to date and the average patient presents 7 to 10 years following initial breast implant placement. Most patients present with delayed seromas, a breast mass, capsular abnormalities, lymphadenopathy, or cutaneous masses. Unlike other forms of non-Hodgkin lymphoma, most cases are cured with surgery alone. The challenge of BIA-ALCL surrounds its rarity-in regard to both its diagnosis as well as the limited available data to guide therapy for more advanced cases. Careful pathology evaluation to analyze both the fluid surrounding the capsule and the capsule itself is critical. Studies to identify which patients are at greater risk of development of this rare entity are ongoing.
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Affiliation(s)
- Neha Mehta-Shah
- 1Division of Oncology, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri; and
| | - Paola Ghione
- 2Division of Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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37
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Choi J, Shin BH, Kim T, Lee JS, Kim S, Choy YB, Heo CY, Koh WG. Micro-textured silicone-based implant fabrication using electrospun fibers as a sacrificial template to suppress fibrous capsule formation. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2022; 135:112687. [DOI: 10.1016/j.msec.2022.112687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/08/2022] [Accepted: 01/22/2022] [Indexed: 11/25/2022]
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38
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FISHER RJ, PAREKH KP, HARSTEN R, IDAEWOR P, SAAD ABDALLA AL-ZAWI A, CHICKEN W. Breast implant-associated anaplastic large cell lymphoma: case report and literature review. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.20.05227-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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39
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Breast implant-associated anaplastic large cell lymphoma: clinical follow-up and analysis of sequential pathologic specimens of untreated patients shows persistent or progressive disease. Mod Pathol 2021; 34:2148-2153. [PMID: 34155351 DOI: 10.1038/s41379-021-00842-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 11/09/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (ALCL) is a distinctive type of T-cell lymphoma that arises around textured-surface breast implants. In a subset of patients, this disease can involve surrounding tissues, spread to regional lymph nodes, and rarely metastasize to distant sites. The aim of this study was to assess sequential pathologic specimens from patients with breast implant-associated ALCL to better understand the natural history of early-stage disease. To achieve this goal, we searched our files for patients who had breast implant-associated ALCL and who had undergone earlier surgical intervention with assessment of biopsy or cytologic specimens. We then focused on the patient subset in whom a definitive diagnosis was not established, and patients did not receive current standard-of-care therapy at that time. We identified a study group of ten patients with breast implant-associated ALCL in whom pathologic specimens were collected 0.5 to 4 years before a definitive diagnosis was established. A comparison of these serial biopsy specimens showed persistent disease without change in pathologic stage in three patients, progression in five patients, and persistence versus progression in two patients. Eventually, six patients underwent implant removal with complete capsulectomy and four underwent partial capsulectomy. Seven patients also received chemotherapy because of invasive disease, three of whom also received radiation therapy, two brentuximab vedotin after chemotherapy failure, and one allogeneic stem cell transplant. Eight patients achieved complete remission and two had partial remission after definitive therapy. At time of last follow-up, six patients were alive without disease, one had evidence of disease, one died of disease, and two patients died of unrelated cancers. In summary, this analysis of sequential specimens from patients with breast implant-associated ALCL suggests these neoplasms persist or progress over time if not treated with standard-of-care therapy.
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40
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Is Breast Implant Associated-Anaplastic Large Cell Lymphoma linked to textured implants? Aesthetic Plast Surg 2021; 45:2593-2601. [PMID: 33837459 DOI: 10.1007/s00266-021-02260-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/21/2021] [Indexed: 12/29/2022]
Abstract
Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL) is a distinctive type of T-cell lymphoma arising around breast implants. We performed a review of the existing literature with the aim of providing an evidence-based overview of the available data on BIA-ALCL with a standardized evaluation of the quality of the studies and investigating the potential association between textured breast implants and BIA-ALCL.We analyzed the literature reporting estimates of relative or absolute risks of BIA-ALCL in case-control, cohort studies and case series studies. The total number of BIA-ALCL cases reported in literature is very low. Furthermore, most of the reported cases have been reported in case-control studies or case series. This means that our knowledge is based on a low level of evidence. Moreover, low-medium quality scores were observed in the included case series studies. In relation to the rarity of the event, better information could only derived by international cooperation to pool together data deriving from all over the world, with the clear need of better reporting patients and implant characteristics in case series and when adding data to public registries. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Stark B, Magnéli M, van Heijningen I, Parreira C, Bösch U, Rouif M, Halle M. Considerations on the Demography of BIA-ALCL in European Countries Based on an E(A)SAPS Survey. Aesthetic Plast Surg 2021; 45:2639-2644. [PMID: 34286385 PMCID: PMC8677632 DOI: 10.1007/s00266-021-02411-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/05/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND A growing body of evidence indicates that breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is associated with the use of certain breast implants. Regional variations have been reported, and a genetic susceptibility has also been suggested. However, large variations in the ability to correctly diagnose BIA-ALCL and to further report and register cases exist between countries and may in part explain variations in the demography. MATERIAL AND METHODS A survey was conducted by The European Association of Societies of Aesthetic Plastic Surgery E(A)SAPS and sent to 48 European countries. The primary aim was to identify the total number of confirmed cases of and deaths from BIA-ALCL in each country during four consecutive measurements over a two-year period. RESULTS An increase in BIA-ALCL cases during four repeated measurements from a total of 305 in April 2019 to 434 in November 2020 was reported by 23 of the 33 responding countries. A nearly 100-fold variation in the number of cases per million inhabitants was noted, where Netherlands had the highest rate (4.12) followed by Finland (1.99). Countries with the lowest reported rates were Austria (0.078), Romania (0.052) and Turkey (0.048). CONCLUSION The current study displays a notable variation ßin the number of confirmed BIA-ALCL cases across Europe, even for countries with established breast implant registers. Variations in diagnosis and reporting systems may explain the differences, but the influence of genetic variations and the prevalence of high-risk implants cannot be excluded. Incomplete sales data along with medical tourism preclude an absolute risk assessment. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Birgit Stark
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
| | - Martin Magnéli
- Institution for Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Ivar van Heijningen
- Plastic Surgery Department, AZ Zeno and Duinbergen Clinic, Knokke-Heist, Belgium
| | - Carlos Parreira
- Hospital Garcia de Orta, Avenue Torrado da Silva, 2805-267, Almada, Portugal
- Clinica Corpuslaser, Av Estados Unidos da America, 100,1ºD, 1700-179, Lisbon, Portugal
| | - Urs Bösch
- Plastic Surgery, MEON Clinic, Lucerne, Switzerland
| | - Michel Rouif
- , 30, Bld Heurteloup, 37000, Tours, Loire Valley, France
| | - Martin Halle
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Gracia-Darder I, Izquierdo N, Boix-Vilanova J, Ramos D. Linfoma anaplásico de células grandes asociado a implantes mamarios. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.ad.2020.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Breast Implant–Associated Anaplastic Large Cell Lymphoma. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Zingaretti N, Vittorini P, Savino V, Vittorini JC, De Francesco F, Riccio M, Parodi PC. Surgical Treatment of Capsular Contracture (CC): Literature Review and Outcomes Utilizing Implants in Revisionary Surgery. Aesthetic Plast Surg 2021; 45:2036-2047. [PMID: 33543344 DOI: 10.1007/s00266-021-02148-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The objective of this clinical review is to provide an overview of the use of breast implants after capsular contracture (CC) surgical treatment, with a focus on type of implants used. Furthermore, our experience in this field is also reviewed. METHODS MEDLINE, EMBASE, Web of Science, Scopus, the Cochrane Central, and Google Scholar databases were reviewed to identify literature related to surgical treatment of capsular contracture and implant replacement. Each article was reviewed by two independent reviewers to ensure all relevant publications were identified. The literature search identified 54 applicable articles. Of these, 26 were found to have a therapeutic level of evidence. The reference lists in each relevant paper were screened manually to include relevant papers not found through the initial search. RESULTS Only four articles report the replacement of implants after surgical treatment of capsular contracture. Six articles reported an implant exchange with only smooth silicone gel filled implants. Two reviews advice to use smooth implants in implant replacement. CONCLUSION With our expertise in the field and the results of this up-to-date literature review, it can be concluded that implant exchange is recommended in case of breast revision for capsular contracture, and the use of subpectoral smooth silicone gel breast implants is a good option after surgical treatment in patients with primary or recurrence Baker III-IV. 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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ALK-Negative Anaplastic Large Cell Lymphoma: Current Concepts and Molecular Pathogenesis of a Heterogeneous Group of Large T-Cell Lymphomas. Cancers (Basel) 2021; 13:cancers13184667. [PMID: 34572893 PMCID: PMC8472588 DOI: 10.3390/cancers13184667] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 12/21/2022] Open
Abstract
Simple Summary ALK- anaplastic large cell lymphoma (ALK- ALCL) is a rare subtype of CD30+ large T-cell lymphoma that typically affects older adults and has a poor prognosis. Recognition of its histopathologic spectrum, subtypes, and of other tumors that can resemble ALK- ALCL is crucial to avoid making a wrong diagnosis that could result in inappropriate treatment for a patient. In recent years, several important studies have identified recurrent molecular alterations that have shed light on the pathogenesis of this lymphoma. However, on the other hand, putting all this vast information together into a concise form has become challenging. In this review, we present not only a more detailed view of the histopathologic findings of ALK- ALCL but also, we attempt to provide a more simplified perspective of the relevant genetic and molecular alterations of this type of lymphoma, that in our opinion, is not available to date. Abstract Anaplastic large cell lymphoma (ALCL) is a subtype of CD30+ large T-cell lymphoma (TCL) that comprises ~2% of all adult non-Hodgkin lymphomas. Based on the presence/absence of the rearrangement and expression of anaplastic lymphoma kinase (ALK), ALCL is divided into ALK+ and ALK-, and both differ clinically and prognostically. This review focuses on the historical points, clinical features, histopathology, differential diagnosis, and relevant cytogenetic and molecular alterations of ALK- ALCL and its subtypes: systemic, primary cutaneous (pc-ALCL), and breast implant-associated (BIA-ALCL). Recent studies have identified recurrent genetic alterations in this TCL. In systemic ALK- ALCL, rearrangements in DUSP22 and TP63 are detected in 30% and 8% of cases, respectively, while the remaining cases are negative for these rearrangements. A similar distribution of these rearrangements is seen in pc-ALCL, whereas none have been detected in BIA-ALCL. Additionally, systemic ALK- ALCL—apart from DUSP22-rearranged cases—harbors JAK1 and/or STAT3 mutations that result in the activation of the JAK/STAT signaling pathway. The JAK1/3 and STAT3 mutations have also been identified in BIA-ALCL but not in pc-ALCL. Although the pathogenesis of these alterations is not fully understood, most of them have prognostic value and open the door to the use of potential targeted therapies for this subtype of TCL.
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Santanelli di Pompeo F, Sorotos M, Clemens MW, Firmani G, Athanasopoulos E, Arctander K, Berenguer B, Bozikov K, Cardoso A, Nord ÅE, Filip C, Georgeskou Romania A, Heitman C, Kaarela O, Kolenda M, Hamdi M, Lantieri L, Lumenta D, Mercer N, Ruegg E, Santanelli di Pompeo F, Stanec Z, Van Der Hulst R, Vranckx JJ. Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): Review of Epidemiology and Prevalence Assessment in Europe. Aesthet Surg J 2021; 41:1014-1025. [PMID: 33022037 DOI: 10.1093/asj/sjaa285] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) epidemiologic studies focus on incidence and risk estimates. OBJECTIVES The aim of this study was to perform a thorough literature review, and to provide an accurate estimate of BIA-ALCL prevalence in Europe. METHODS We searched PubMed, Web of Science, SCOPUS, and Google Scholar databases to identify publications reporting BIA-ALCL epidemiology. Research was conducted between November 2019 and August 2020. European prevalence was assessed as the ratio between pathology-confirmed cases and breast implant-bearing individuals. The Committee on Device Safety and Development (CDSD) collected data from national plastic surgery societies, health authorities, and disease-specific registries to calculate the numerator. The denominator was estimated by combining European demographic data with scientific reports. RESULTS Our research identified 507 articles: 106 were excluded for not being relevant to BIA-ALCL. From the remaining 401 articles, we selected 35 that discussed epidemiology and 12 reviews. The CDSD reported 420 cases in Europe, with an overall prevalence of 1:13,745 cases in the 28 member states of the European Union (EU-28). Countries where specific measures have been implemented to tackle BIA-ALCL account for 61% of the EU-28 population and actively reported 382 cases with an overall prevalence of 1:9121. CONCLUSION Countries where specific measures have been implemented show a higher prevalence of BIA-ALCL compared with the European mean, suggesting that these countries have improved the detection of the condition and reduced underreporting, which affects the numerator value. Other nations should adopt projections based on these measures to avoid underestimating how widespread BIA-ALCL is. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Michail Sorotos
- Department of Medicine, Surgery and Dentistry, PhD School of Translational Medicine of Development and Active Ageing, Università degli Studi di Salerno, Salerno, Italy
| | - Mark W Clemens
- Department of Plastic Surgery, M.D. Anderson Cancer Center, TX, USA
| | - Guido Firmani
- School of Medicine and Psychology, Sapienza University, Rome, Italy
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ChartSweep: A HIPAA-compliant Tool to Automate Chart Review for Plastic Surgery Research. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3633. [PMID: 34150426 PMCID: PMC8205215 DOI: 10.1097/gox.0000000000003633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/14/2021] [Indexed: 01/20/2023]
Abstract
Retrospective chart review (RCR) is the process of manual patient data review to answer research questions. Large and heterogeneous datasets make the RCR process time-consuming, with potential to introduce errors. The authors therefore designed and developed ChartSweep to expedite the RCR process while remaining faithful to its methodological rigor. ChartSweep is an open-source tool that can be customized for use with any electronic health record system. ChartSweep was developed by the authors to extract information from electronic health records using the Python coding language. As proof-of-concept, the tool was tested in three studies: RCR1-Identification of subjects who underwent radiofrequency ablation in a cohort of patients who had undergone headache surgery (n = 172); RCR2-Identification of patients with a diagnosis of thoracic outlet syndrome in patients who underwent peripheral neuroplasty (n = 806); RCR3-Identification of patients with a history of implant illness or breast implant-associated anaplastic large cell lymphoma in patients who had undergone implant-based breast augmentation or reconstruction (n = 1133). Inter-rater reliability was assessed. ChartSweep reduced the time required to conduct RCR1 by 1315 minutes (21.9 hours), RCR2 by 1664 minutes (27.7 hours), and RCR3 by 2215 minutes (36.9 hours). Inter-rater reliability was uncompromised (k = 1.00). Open-source Python libraries as leveraged by ChartSweep significantly accelerate the RCR process in plastic surgery research. Quality of data review is not compromised. Further analyses with larger, heterogeneous study populations are required to further validate ChartSweep as a research tool.
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The Case for Breast Implant Removal or Replacement Without Capsulectomy. Aesthetic Plast Surg 2021; 45:1338-1341. [PMID: 33575879 PMCID: PMC8144086 DOI: 10.1007/s00266-020-02079-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/26/2020] [Indexed: 12/14/2022]
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Tripodi D, Amabile MI, Varanese M, D'Andrea V, Sorrenti S, Cannistrà C. Large cell anaplastic lymphoma associated with breast implant: a rare case report presentation and discussion of possible management. Gland Surg 2021; 10:2076-2080. [PMID: 34268093 DOI: 10.21037/gs-20-853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/19/2021] [Indexed: 11/06/2022]
Abstract
Anaplastic large cell lymphomas (ALCL) are a rare type of primary breast lymphoma. The association between breast implants and ALCL was first described in 1997. Breast implant associated (BIA)-ALCL arises from the inflammatory T cells surrounding the fibrous capsule, and most tumors are in situ. Here we present the case of a 60-year-old woman with ALCL following bilateral silicone breast prosthesis implantation for aesthetic reason. The patient presented at our observation 7 years following the first surgery reporting a sport trauma in the right thoracic region with breast enlargement and tenderness, complaining breast pain at the palpation of the right breast. Imaging study showed a right fluid collection surrounding the affected breast implant. For this reason, the patient underwent bilateral complete capsulectomy (surgical specimen histologically analyzed and resulted negative for ALCL) and implantation of new breast silicone prosthesis. In 10 months, a progressive relapse of the symptoms with a right peri-implant fluid collection restauration was documented and bilateral surgical removal of breast prostheses with right peri-implant capsular biopsy were performed. The histological analysis of the peri-implant capsule laid for ALCL cellules and a new radical surgical excision of bilateral periprothesic capsule was performed followed by adjuvant radiotherapy for a skin relapse of the disease with a subsequent complete remission. No further relapse was observed afterwards. This clinical case raised a series of diagnostic and therapeutic issues highlighting similarities with previous BIA-ALCL reports, but also some peculiarities that deserve to be further investigated and described in order to make an early recognition of the disease for the proper management and treatment of the patient. Due to the rarity of these tumors, rapidly diagnosing a BIA-ALCL case, not neglecting other associated symptoms or signs, is essential to ensure timely and safe treatment.
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Affiliation(s)
- Domenico Tripodi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Maria Ida Amabile
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Marzia Varanese
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Vito D'Andrea
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Claudio Cannistrà
- Centre Hospitalier Universitaire Bichat Claude-Bernard, Paris, France
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Marchac A, El Haddad R, Boedec C, DE Greef C, Dubrulle F, Garcia Perez J, Rostane Renouard D, Sanchez Nebreda M, Morral S, Sanchez Lagarejo E, Moran Montepeque JL, Terezanov O, Fink V, DE Mortillet S, Gounot N, Bricout N. Three-Year Intermediate Results of a Prospective Multicenter Study Investigating the use of Smooth, Semi-Smooth, Microtextured and Macrotextured Implants from a Single Manufacturer in Breast Augmentation and Reconstruction Procedures. J Plast Reconstr Aesthet Surg 2021; 74:3150-3157. [PMID: 34088647 DOI: 10.1016/j.bjps.2021.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 11/11/2020] [Accepted: 01/24/2021] [Indexed: 11/19/2022]
Abstract
Silicone gel-filled implants exist in a wide range of shapes and textures, and yet there are relatively few long-term large-scale studies, particularly on recently developed "semi-smooth" implants. The present study fills this gap by presenting the 3-year findings from an ongoing 10-year multicenter prospective study on breast implants with four different surface types: smooth, semi-smooth, microtextured, and macrotextured. A total of 908 patients were recruited in 15 investigational sites across Europe and divided into three groups: 653 primary augmentations in Group 1, 144 revision augmentations in Group 2, and 111 reconstructions in Group 3. All 4 types of implant shells were manufactured by the same company using the same silicone material. Surgeons were free to choose their preferred technique and implant surface, but data were collected using a standardized software and included all complications, and satisfaction levels reported by the patients at each visit. The incidence of post-operative complications was estimated based on Kaplan-Meier risk rates, on a per patient basis. At 3 years post implantation, capsular contracture (Baker grade III/IV) was the most common complication, with a per-patient risk rate of 1.5% in Group 1. Interestingly, there was no capsular contracture in this group when semi-smooth implants were used. The risk of implant rupture in Group 1 was 0.2%. The preliminary findings of this 10-year prospective study indicate that, 3 years after the operation, the four types of silicone gel-filled implants investigated were safe, with a low complication rate in comparison with the most favorable results published in other similar studies.
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