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Longo B, Curigliano G, Cervelli V. Comment on "Reply: Comment on BIA-ALCL: Comparing the Risk Profiles of Smooth and Textured Breast Implants". Aesthetic Plast Surg 2024; 48:3051-3052. [PMID: 37610519 DOI: 10.1007/s00266-023-03556-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/30/2023] [Indexed: 08/24/2023]
Affiliation(s)
- Benedetto Longo
- Chair of Plastic Surgery, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Via Montpellier, 1 - 00133, Rome, Italy.
| | - Giuseppe Curigliano
- Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Haemato-Oncology, University of Milano, Milan, Italy
- Group of Experts on BIA-ALCL, The Italian Ministry of Health, Rome, Italy
| | - Valerio Cervelli
- Chair of Plastic Surgery, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Via Montpellier, 1 - 00133, Rome, Italy
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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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Ma IZ, Chung JH, Kim J, Hong KY. Bilateral late hematomas after breast augmentation mimicking anaplastic large cell lymphoma: A case report. Medicine (Baltimore) 2023; 102:e36231. [PMID: 38050280 PMCID: PMC10695614 DOI: 10.1097/md.0000000000036231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/31/2023] [Indexed: 12/06/2023] Open
Abstract
RATIONALE Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is rare, but its incidence has recently increased. It is characterized by a sudden onset of seroma collection after implantation of textured breast implants. However, BIA-ALCL may be confused with late hematoma, which is also a rare finding in aesthetic breast surgery. The cause of late hematoma is mostly unknown, and patients rarely present with specific symptoms. PATIENT CONCERNS We presented a case of late hematoma that occurred in a patient who underwent augmentation mammoplasty 25 years ago and was on anticoagulants for 7 years. DIAGNOSES Ultrasonography and magnetic resonance imaging could not rule out the possibility of BIA-ALCL. INTERVENTIONS Bilateral implant removal was performed, and massive amounts of late hematoma and organizing tissues were removed. OUTCOMES The pathologists confirmed the biopsy results as late hematoma with organizing tissues. Capsules from both sides were confirmed as fibrous capsules with chronic inflammation and foamy macrophage infiltration. LESSONS Although malignancy needs to be primarily ruled out, late hematoma can occur beyond expectations, especially in anticoagulated patients, and must be included in the differential diagnosis.
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Affiliation(s)
- I Zhen Ma
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jee Hyeok Chung
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jinhyun Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ki Yong Hong
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Vittoria L, Sala L, Summo V, Capone I, Conca E, Toma M, Ottolenghi J, Testa F, Cortinovis U, Paolini B, Cabras A, Aiello A, Bozzi F. Breast implant associated anaplastic large cell lymphoma: Evidence for an efficient diagnostic workup. TUMORI JOURNAL 2023; 109:458-465. [PMID: 36942354 PMCID: PMC10540484 DOI: 10.1177/03008916231157837] [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: 10/13/2022] [Revised: 12/31/2022] [Accepted: 01/27/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION During the last few years it has been shown that an anaplastic T cell lymphoma can develop as a rare and late sequelae of implant-based breast reconstruction. This malignancy was recognized in the 2017 by WHO and named breast implant associated anaplastic large T cell lymphoma (BIA-ALCL). BIA-ALCL usually presents as abundant effusion around the implant, thus, in addition to cytology smears, its diagnosis also requires immunohistochemistry, T cells clonality and cytometry. Due to the increasing attention of clinicians, it is likely that the number of the BIA-ALCL suspected cases will grow in the future, implying the necessity of a reliable and cost-effective diagnostic procedure. METHODS To achieve this goal, we retrospectively analyzed the results of laboratory investigations performed at our Institute (Fondazione IRCCS Istituto Nazionale dei Tumori Milan, Italy) on 44 effusions obtained from 31 women suspected for BIA-ALCL. RESULTS Through cytology, eight out of 44 effusions showed the presence of BIA-ALCL cells. Lymphoma cells were than confirmed in seven samples by immunohistochemistry and/or T cell clonality and/or cytometry. Overall, cytology showed 100% sensitivity, 97% specificity and positive and negative predictive values of 87.5% and 100% respectively. Further analyses were particularly useful in effusions showing small percentages of BIA-ALCL cells. Moreover, an extended cytometric profile that can be applied when fast confirmation of the cytologic result is required was also identified. CONCLUSIONS Our results evidenced a central role of cytopathology in the management of BIA-ALCL suspected effusions and suggested that further laboratory investigations might be applied only in cases showing atypical/activated lymphoid cells through cytology.
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Affiliation(s)
- Laura Vittoria
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Sala
- Department of Plastic Reconstructive Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valeria Summo
- Department of Plastic Reconstructive Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Iolanda Capone
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Conca
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Martina Toma
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Joseph Ottolenghi
- Department of Plastic Reconstructive Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesca Testa
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Laboratory of Analysis and Pathology, Policlinico Monza, Italy
| | - Umberto Cortinovis
- Department of Plastic Reconstructive Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Biagio Paolini
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Antonello Cabras
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Antonella Aiello
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Fabio Bozzi
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Brondeel S, Rogge F, De Wolf E, Decuypere F, Casaer B. EBV-Positive Diffuse Large B-Cell Lymphoma in Association with Polyurethane Textured Breast Implants: Case Report and Literature Overview. Aesthetic Plast Surg 2023:10.1007/s00266-023-03377-0. [PMID: 37173414 DOI: 10.1007/s00266-023-03377-0] [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: 11/29/2022] [Accepted: 04/23/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Lymphomas associated with breast implants are mostly of the T-cell type which typically present as a late-onset seroma or palpable mass adjacent to the implant. Primary lymphomas of the breast, in the absence of breast implants, are mostly of the B-cell type. However, we present a case of an Epstein-Barr virus-positive diffuse large B-cell lymphoma in a patient with polyurethane textured implants. CASE A 75-year-old woman presented with a sudden onset of swelling in her right breast. Her medical history revealed a unilateral mastectomy at the age of 48 for an invasive ductal adenocarcinoma in her left breast. Reconstruction was performed using bilateral McGhan style 150 implants. Nine years later, she was diagnosed with Baker IV capsular contracture and bilateral rupture, as seen on magnetic resonance imaging. A complete capsulectomy with implant change (Polytech, Replicon® SL HP) and mastopexy on the right was performed. Given her history and the sudden onset of swelling, the situation was concerning. Ultrasound showed a large mass in contact with the implant and an effusion around it. After mastectomy with explantation and capsulectomy, she was diagnosed with an Epstein-Barr virus-associated diffuse large B-cell lymphoma (DLBCL) of the capsule in association with textured breast implants. CONCLUSION We report the first case of polyurethane textured implant association with the rare entity of EBV+ DLBCL. Our aim is to renew awareness of the clinical significance of late periprosthetic seroma and highlight the need for documenting all cases to advance our understanding of breast implant-associated lymphoma. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Sam Brondeel
- Department of Plastic, Reconstructive and Aesthetic surgery, AZ Sint-Jan, Ruddershove 10, 8000, Brugges, Belgium
| | - Fabrice Rogge
- Department of Plastic, Reconstructive and Aesthetic surgery, AZ Sint-Jan, Ruddershove 10, 8000, Brugges, Belgium
| | - Edward De Wolf
- Department of Plastic, Reconstructive and Aesthetic surgery, AZ Sint-Jan, Ruddershove 10, 8000, Brugges, Belgium
| | - Fien Decuypere
- Department of Plastic, Reconstructive and Aesthetic surgery, AZ Sint-Jan, Ruddershove 10, 8000, Brugges, Belgium
| | - Bob Casaer
- Department of Plastic, Reconstructive and Aesthetic surgery, AZ Sint-Jan, Ruddershove 10, 8000, Brugges, Belgium.
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Feng R, Huang W, Chen L, Min J, Shu W, Yu Y, Wang X, Cao X, Liu B. Clinicopathological characteristics, local treatment, and prognostic factors in IE/IIE primary breast lymphoma: a retrospective study of 67 patients. World J Surg Oncol 2023; 21:127. [PMID: 37032326 PMCID: PMC10084664 DOI: 10.1186/s12957-023-03007-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/30/2023] [Indexed: 04/11/2023] Open
Abstract
INTRODUCTION Primary breast lymphoma (PBL) is a rare disease, treatment of which excerpts does not reach a consensus. This retrospective study was conducted to analyze clinical features and survival outcomes of different therapeutic methods. MATERIALS AND METHODS Records of 67 patients with stage IE/IIE primary breast lymphoma were reviewed from the medical record system. Survival information was gathered by searching the outpatient system. Clinicopathological characteristics were compared by chi-squared or Fisher's exact tests. A comparison of survival curves was performed by log-rank tests. The Cox proportional hazard model was applied for multivariate analysis. RESULTS At the median follow-up time of 65.23 months (range, 9-150 months), there were 27 (40.3%) relapses, 28 (41.8%) distant metastases, and 21 (31.3%) deaths. The 5-year progression-free survival (PFS) and overall survival (OS) were 52.1% and 72.4%. Pathological types (DLBCL vs. non-DLBCL, p = 0.001) and rituximab use (p < 0.001) were statistically associated with longer PFS in patients with PBL. Nodal sites involved and radiotherapy administration were significant predictors for 5-year OS. Multivariate analysis suggested that nodal sites involved (p = 0.005) and radiotherapy administration (p < 0.003) were independent prognostic factors for OS in patients with PBL (p < 0.05). Radical surgery was not an independent factor for patients with PBL. CONCLUSIONS Radiotherapy improved the survival of patients with PBL. Radical mastectomy offered no additional benefit in the treatment of PBL.
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Affiliation(s)
- Ruigang Feng
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, 300060, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
- Department of General Surgery, Second Central Hospital of Baoding, Baoding, 072750, China
| | - Wenwen Huang
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, 300060, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
- Department of General Surgery, The Second Hospital of Chifeng, Chifeng, 024000, China
| | - Lixuan Chen
- Five Department of Oncology, Shijiazhuang People's Hospital, Shijiazhuang, 050000, China
| | - Jie Min
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, 300060, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Wenjun Shu
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, 300060, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Yue Yu
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, 300060, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Xin Wang
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, 300060, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Xuchen Cao
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, 300060, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Bowen Liu
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, 300060, China.
- Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China.
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.
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Santanelli di Pompeo F, Sorotos M, Paolini G, D’Orsi G, Firmani G. The use of Fat-Augmented Latissimus Dorsi (FALD) flap for male Poland Syndrome correction: a case report. Case Reports Plast Surg Hand Surg 2022; 9:197-202. [PMID: 36105868 PMCID: PMC9467619 DOI: 10.1080/23320885.2022.2117701] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
We present a 23-year-old male patient with severe PS, characterized by marked left thoracic wall deformity. Reconstruction was performed using the Fat-Augmented Latissimus Dorsi flap, which was fixed to the chest wall hollowing corresponding to where the pectoralis major muscle was missing. Patient was satisfied with final aesthetic and functional result.
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Affiliation(s)
- Fabio Santanelli di Pompeo
- Department NESMOS – Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
- Chair of Plastic Surgery, Faculty of Medicine and Psychology, Sapienza University of Rome – Sant’Andrea Hospital, Rome, Italy
| | - Michail Sorotos
- Department NESMOS – Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Guido Paolini
- Department NESMOS – Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Gennaro D’Orsi
- Department NESMOS – Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Guido Firmani
- Department NESMOS – Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Mankowski P, Carr M, Cherukupalli A, Bovill E, Lennox P, Brown MH, Carr N. The Macrotextured Implant Recall: Breast Implant-Associated-Anaplastic Large Cell Lymphoma Risk Aversion in Cosmetic and Reconstructive Plastic Surgery Practices. Aesthet Surg J 2022; 42:1408-1413. [PMID: 35709374 DOI: 10.1093/asj/sjac158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The recall of Allergan Biocell (Irvine, CA) devices due to the association between anaplastic large cell lymphoma (ALCL) and macrotextured breast implants means that plastic surgeons are faced with the challenge of caring for patients with these implants in situ. Cosmetic and reconstructive surgeons have been contacting affected patients to encourage them to follow up and discuss the most appropriate risk-reduction strategies. OBJECTIVES The aim of this study was to evaluate patient concerns about the risk of breast implant-associated ALCL (BIA-ALCL) and to compare management differences between cosmetic and reconstructive patients. METHODS A retrospective review was performed of 432 patients with macrotextured implants who presented to clinic after being contacted (121 reconstructive and 311 cosmetic). These records were analyzed for their presenting concerns, surgery wait times, and management plans. Statistical analysis was performed to compare the cohorts, and odds ratios (ORs) were computed to determine the association between patient concerns and their choice of management. RESULTS After consultation, 59.5% of the reconstructive cohort and 49.5% of the cosmetic cohort scheduled implant removal or exchange. The reconstructive population had a higher rate of ALCL concern (62.7%); however, both cohorts had a significant OR, demonstrating an expressed fear of ALCL likely contributed to their subsequent clinical management (OR cosmetic, 1.66; OR reconstructive, 2.17). CONCLUSIONS Although the risk of ALCL appears to be more concerning to the reconstructive population, both cohorts were equally motivated to have their implants removed. Informing patients about their ALCL risk is crucial to ensure a patient-supported risk reduction plan. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Peter Mankowski
- University of British Columbia Department of Surgery, Division of Plastic Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| | - Matthew Carr
- University of British Columbia Department of Surgery, Division of Plastic Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| | - Abhiram Cherukupalli
- University of British Columbia Department of Surgery, Division of Plastic Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| | - Esta Bovill
- University of British Columbia Department of Surgery, Division of Plastic Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| | - Peter Lennox
- University of British Columbia Department of Surgery, Division of Plastic Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| | - Mitchell H Brown
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Carr
- University of British Columbia Department of Surgery, Division of Plastic Surgery, Vancouver General Hospital, Vancouver, BC, Canada
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9
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Di Pompeo FS, Panagiotakos D, Firmani G, Sorotos M. BIA-ALCL Epidemiological Findings From a Retrospective Study of 248 Cases Extracted from Relevant Case Reports and Series: A Systematic Review. Aesthet Surg J 2022; 43:545-555. [PMID: 36441968 DOI: 10.1093/asj/sjac312] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The epidemiologic picture of Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL) is unclear, with no high-level evidence, as only case reports and series are available. OBJECTIVES We aimed at updating the BIA-ALCL epidemiology by using all available data through a systematic review of scientific literature. METHODS A search on PubMed, Scopus, and Web of Science was conducted between October 2021 and April 2022. Out of the 2,799 available records, we selected 114 pertinent articles, featuring 248 BIA-ALCL cases which were retrospectively analyzed by means of descriptive statistics, incidence rate (IR), Kaplan-Meier survival curves and Pearson correlation coefficient. RESULTS United States, Netherlands, Italy, and Australia were the most reporting countries. Mean age at 1st implantation was 42y, and 53y at diagnosis. Aesthetic indication was 52% and reconstructive 48%, macrotextured surface was linked to 73.8% of cases and seroma to 83%. Total follow-up was 492 months, mean Event Free Time (EFT) to BIA-ALCL development was 129 months. IR was 96 new cases/1.000 women per year after first implantation, and directly correlated to number of replacements. EFT was directly correlated to number of replacements, implant rupture and capsule contracture, while inversely associated to patients' age at first implantation and to BRACA1/2 and TP53 mutations. CONCLUSIONS Macrotextured implants use in older patients and in BRCA1/2 and TP53 mutated should be reconsidered, being associated to earlier disease onset. Implant replacement of asymptomatic, risk-stratified patients, can be indicated due to its protective role against BIA-ALCL, reducing IR rate and risk, while increasing the EFT.
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Affiliation(s)
- Fabio Santanelli Di Pompeo
- Faculty of Medicine and Psychology, Sapienza University of Rome, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sant' Andrea Hospital, Via di Grottarossa, Rome, Italy
| | - Demosthenes Panagiotakos
- Research Methods and Epidemiology, School of Health Sciences and Education, Harokopio University in Athens, Athens, Greece
| | - Guido Firmani
- Faculty of Medicine and Psychology, Sapienza University of Rome, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sant' Andrea Hospital, Via di Grottarossa, Rome, Italy
| | - Michail Sorotos
- Faculty of Medicine and Psychology, Sapienza University of Rome, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sant' Andrea Hospital, Via di Grottarossa, Rome, Italy
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10
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Santanelli di Pompeo F, Clemens MW, Atlan M, Botti G, Cordeiro PG, De Jong D, Di Napoli A, Hammond D, Haymaker CL, Horwitz SM, Hunt K, Lennox P, Mallucci P, Miranda RN, Munhoz AM, Swanson E, Turner SD, Firmani G, Sorotos M. 2022 Practice Recommendation Updates From the World Consensus Conference on BIA-ALCL. Aesthet Surg J 2022; 42:1262-1278. [PMID: 35639805 PMCID: PMC9924046 DOI: 10.1093/asj/sjac133] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Laboratory and clinical research on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is rapidly evolving. Changes in standard of care and insights into best practice were recently presented at the 3rd World Consensus Conference on BIA-ALCL. OBJECTIVES The authors sought to provide practice recommendations from a consensus of experts, supplemented with a literature review regarding epidemiology, etiology, pathogenesis, diagnosis, treatment, socio-psychological aspects, and international authority guidance. METHODS A literature search of all manuscripts between 1997 and August 2021 for the above areas of BIA-ALCL was conducted with the PubMed database. Manuscripts in different languages, on non-human subjects, and/or discussing conditions separate from BIA-ALCL were excluded. The study was conducted employing the Delphi process, gathering 18 experts panelists and utilizing email-based questionnaires to record the level of agreement with each statement by applying a 5-point Likert Scale. Median response, interquartile range, and comments were employed to accept, reject, or revise each statement. RESULTS The literature search initially yielded 764 manuscripts, of which 405 were discarded. From the remaining 359, only 218 were included in the review and utilized to prepare 36 statements subdivided into 5 sections. After 1 round, panelists agreed on all criteria. CONCLUSIONS BIA-ALCL is uncommon and still largely underreported. Mandatory implant registries and actions by regulatory authorities are needed to better understand disease epidemiology and address initial lymphomagenesis and progression. Deviation from current diagnosis and treatment protocols can lead to disease recurrence, and research on breast implant risk factors provide insight to etiology. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Fabio Santanelli di Pompeo
- Corresponding Author: Prof Fabio Santanelli di Pompeo, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sant’Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy. E-mail: ; Instagram: @diepflap.it
| | - Mark W Clemens
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA and is a Breast Surgery section editor for Aesthetic Surgery Journal
| | - Michael Atlan
- Aesthetic Plastic Reconstructive Unit/CHU TENON PARIS—APHP, Université Pierre et Marie Curie, Paris, France
| | | | - Peter G Cordeiro
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Daphne De Jong
- Amsterdam UMC-Vrije Universiteit Amsterdam, Department of Pathology and Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Arianna Di Napoli
- Pathology Unit, Department of Clinical and Molecular Medicine, Sapienza University, Sant’Andrea Hospital, Rome, Italy
| | | | - Cara L Haymaker
- Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven M Horwitz
- Lymphoma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Kelly Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Lennox
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, BC, Canada and is a clinical editor for Aesthetic Surgery Journal
| | | | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexandre M Munhoz
- Plastic Surgery Department, Hospital Moriah, Hospital Sírio-Libanês, Higienópolis, São Paulo, Brazil
| | | | - Suzanne D Turner
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Guido Firmani
- Faculty of Medicine and Psychology, Sapienza University of Rome, Department of Plastic Surgery, Sant’Andrea Hospital, Rome, Italy
| | - Michail Sorotos
- Faculty of Medicine and Psychology, Sapienza University of Rome, Department NESMOS, Sant’Andrea Hospital, Rome, Italy
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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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Santanelli di Pompeo F, Paolini G, Firmani G, Sorotos M. HISTORY OF BREAST IMPLANTS: BACK TO THE FUTURE. JPRAS Open 2022; 32:166-177. [PMID: 35434240 PMCID: PMC9006741 DOI: 10.1016/j.jpra.2022.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/27/2022] [Indexed: 11/19/2022] Open
Abstract
Modern breast implants are a staple of plastic surgery, finding uses in esthetic and reconstructive procedures. Their history began in the 1960s, with the first generation of smooth devices with thick silicone elastomer, thick silicone gel, and Dacron patches on the back. They presented hard consistency, high capsular contracture rates and the patches increased the risk of rupture. In the same decade, polyurethane coating of implants was implemented. A second generation was introduced in the 1970s with a thinner shell, less viscous gel filler and no patches, but increased silicone bleed-through and rupture rates. The third generation, in the early 1980s, featured implants with a thicker multilayered elastomer shell reinforced with silica to reduce rupture risk and prevent silicone bleed-through. A fourth generation from the late 1980s combined thick outer elastomer shells, more cohesive gel filler, and implemented for the first-time outer shell texturing. In the early 1990s, the fifth generation of devices pioneered an anatomical shape with highly cohesive form-stable gel filler and a rough outer shell surface. Surface texturing was hampered by the discovery of Breast Implant Associated-Anaplastic Large Cell Lymphoma and its link with textured devices. From the 2010s, we have the era of the sixth generation of implants, featuring innovations regarding the surface, with biomimetic surfaces, more resistant shells and variations in gel consistency. The road to innovation comprises setbacks such as the FDA moratorium in 1992, the PIP scandal, the Silimed CE mark temporary suspension and the FDA-requested voluntary recall of the Allergan BIOCELL implants.
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Stachon H, Amoroso V, Urban C, Bioni P, Spautz C, Lima RSD, Anselmi K, Kuroda F, Rabinovich I, Alvarez T, Monteiro J. Intraoperative Assessment of Endogenous Microbiota in the Breast. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:759-764. [PMID: 34784632 PMCID: PMC10183903 DOI: 10.1055/s-0041-1736300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Breast surgery is considered a clean surgery; however, the rates of infection range between 3 and 15%. The objective of the present study was to intraoperatively investigate the presence of autochthonous microbiota in the breast. METHODS Pieces of breast tissue collected from 49 patients who underwent elective breast surgery (reconstructive, diagnostic, or oncologic) were cultured. The pieces of breast tissue were approximately 1 cm in diameter and were removed from the retroareolar area, medial quadrant, and lateral quadrant. Each piece of tissue was incubated in brain heart infusion (BHI) broth for 7 days at 37°C, and in cases in which the medium became turbid due to microorganism growth, the samples were placed in Petri dishes for culturing and isolating strains and for identifying species using an automated counter. RESULTS Microorganism growth was observed in the samples of 10 of the 49 patients (20.4%) and in 11 of the 218 pieces of tissue (5%). The detected species were Staphylococcus lugdunensis, Staphylococcus hominis, Staphylococcus epidermidis, Sphingomonas paucimobilis, and Aeromonas salmonicida. No patient with positive samples had clinical infection postoperatively. CONCLUSION The presence of these bacteria in breast tissue in approximately 20% of the patients in this series suggests that breast surgery should be considered a potential source of contamination that may have implications for adverse reactions to breast implants and should be studied in the near future for their oncological implications in breast implant-associated large-cell lymphoma etiology.
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Affiliation(s)
- Henrique Stachon
- Postgraduate Program, Biotechnology, Universidade Positivo, Curitiba, PR, Brazil
| | - Vanessa Amoroso
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| | - Cicero Urban
- Postgraduate Program, Biotechnology, Universidade Positivo, Curitiba, PR, Brazil.,Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| | - Pamela Bioni
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| | - Cleverton Spautz
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| | | | - Karina Anselmi
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| | - Flávia Kuroda
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| | - Iris Rabinovich
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| | - Thabata Alvarez
- Postgraduate Program, Biotechnology, Universidade Positivo, Curitiba, PR, Brazil
| | - Juliane Monteiro
- Microbiology Laboratory, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
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14
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The management of breast implant-associated anaplastic large cell lymphoma in the setting of pregnancy: seeking for clinical practice guidelines. Arch Plast Surg 2021; 48:373-377. [PMID: 34352947 PMCID: PMC8342241 DOI: 10.5999/aps.2021.00185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/27/2021] [Indexed: 11/08/2022] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently described form of T-cell non-Hodgkin lymphoma now formally recognized by the World Health Organization classification of lymphoid neoplasms. The aim of this paper is to report the first case of BIA-ALCL diagnosed in a pregnant patient. It is well known that BIA-ALCL appears as an indolent lymphoma with a good prognosis when diag-nosed at early stages and clinical guidelines for its management have been clearly published. Nevertheless, they lack a standardized approach for BIA-ALCL during pregnancy. With limited experience in our case, treatment has been safely postponed after term without affecting patient’s overall prognosis and without fetal complication. The fact that the disease was diagnosed at an early stage (stage I) undoubtedly influenced the course of treatment. A multidisciplinary approach weighing the risks and benefits of treatment is of paramount importance in order to ensure the best possible outcome for both the mother and her child and clinical update guidelines should be issued.
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15
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Evaluating the Necessity of Capsulectomy in Cases of Textured Breast Implant Replacement. Ann Plast Surg 2021; 85:691-698. [PMID: 32102001 DOI: 10.1097/sap.0000000000002301] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Capsulectomy has traditionally been recommended as a treatment for capsular contracture after breast augmentation. With the advent of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL), and the Food and Drug Administration's decision to ban Biocell textured devices, this operation has taken on new importance. This review was undertaken to better inform clinical recommendations for women with textured devices. METHODS An electronic search was performed using PubMed to identify all the available literature on the subject of capsulectomy and open capsulotomy (the alternative treatment). RESULTS Fifty-seven articles on this topic were identified. Capsulectomy was widely recommended for treatment of capsular contracture, although many authors recommended leaving thin capsular tissue behind in the absence of symptoms. En bloc resection was recommended only for women with a diagnosis of BIA-ALCL. No information supported a prophylactic role for capsulectomy in asymptomatic women with textured breast implants who are concerned regarding their future risk of BIA-ALCL. Routine pathologic examination in asymptomatic patients was not supported. DISCUSSION Capsulectomy adds substantially to the surgical risk, discomfort, recovery time, and expense. Implant removal or replacement without a simultaneous capsulectomy is atraumatic and poses negligible risk. CONCLUSIONS Capsulectomy introduces additional morbidity and is not mandatory for asymptomatic patients. Implant removal or exchange for smooth implants without a capsulectomy may be an acceptable choice for many women who do not demonstrate capsular pathology. However, any symptoms or surgical findings suggesting pathology warrant a capsulectomy. En bloc resections are reserved for patients diagnosed with BIA-ALCL.
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16
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Analysis of Allergan's Biocell Implant Recall in a Major University Breast Center. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2906. [PMID: 32766057 PMCID: PMC7339368 DOI: 10.1097/gox.0000000000002906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/15/2020] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Background: In May 2019, Health Canada released a national recall of all macrotextured breast implants that later became international in July 2019 regarding increasing accounts of suspected breast implant–associated anaplastic large cell lymphoma. In Canada, this recall targeted Allergan’s Biocell implants. This report presents the postmortem of this comprehensive single-center recall, which had to be undertaken in a limited time. Methods: Four months after the beginning of the recall, the authors analyzed the transcript of meetings to characterize the team assembled during the recall. Then, to reconstruct the systemic work plan as well as the crucial steps and actors of the recall process, a chronologic table of the 5 meetings held during the recall, agendas and transcripts of every meeting, electronic correspondences, and other documents created during the recall were consulted. Results: Between 1996 and 2018, 1260 women were affected by the recall, meaning that they received Allergan’s macrotextured implants. Ninety-two patients underwent explantation of the device or will undergo implant explantation. To this day, no patient was diagnosed with breast implant–associated anaplastic large cell lymphoma. Conclusions: Our center’s experience highlights the utmost importance of building a national breast implants registry. We recommend breast centers to develop preestablished crisis centers and train staff to better prepare for future device recalls and minimize waste of time. Finally, we believe that implants should be identified based on the characteristics rather than their brand name.
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17
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St Cyr TL, Pockaj BA, Northfelt DW, Craig FE, Clemens MW, Mahabir RC. Breast Implant-Associated Anaplastic Large-Cell Lymphoma: Current Understanding and Recommendations for Management. Plast Surg (Oakv) 2020; 28:117-126. [PMID: 32596187 PMCID: PMC7298574 DOI: 10.1177/2292550320925906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Worldwide, millions of women live with breast implants. Therefore, it is important that physicians be aware of an uncommon but possibly serious complication arising from breast implants: breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Breast implant-associated anaplastic large-cell lymphoma most commonly presents as a delayed fluid collection around a textured breast implant or as a mass in the capsule surrounding the implant. The exact pathogenesis of the disease remains unclear. The neoplastic cells of BIA-ALCL show strong uniform staining for CD30 and are consistently negative for activin receptor-like kinase 1. Patients with confirmed cases should be referred to a lymphoma specialist or breast medical oncologist for a complete oncologic evaluation before any surgical intervention. For disease confined to the fluid accumulation or capsule, or both, surgical removal of the implant and complete capsulectomy is the preferred treatment. Postoperative chemotherapy or radiation, or both, are not considered necessary for patients with limited-stage disease and are reserved for advanced disease stages. Generally, BIA-ALCL is a local disease that follows an indolent course and has an excellent prognosis. Although complete remission of disease has occurred in patients with BIA-ALCL, median overall survival is reduced. As of March 2018, approximately 529 unique, confirmed BIA-ALCL cases had been reported in 23 countries. To date, 16 patients have died from BIA-ALCL, and all had extracapsular involvement. The aim of this article is to summarize the diagnosis, evaluation, and management of BIA-ALCL, based on established guidelines, for all practitioners who may care for patients with breast implants.
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Affiliation(s)
- Tessa L St Cyr
- Mayo Clinic School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Barbara A Pockaj
- Division of General Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Donald W Northfelt
- Division of Hematology and Medical Oncology, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Fiona E Craig
- Division of Hematopathology, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Mark W Clemens
- Department of Plastic Surgery, Division of Surgery, MD Anderson Cancer Center, Houston, TX, USA
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18
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K Groth A, Graf R. Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) and the Textured Breast Implant Crisis. Aesthetic Plast Surg 2020; 44:1-12. [PMID: 31624894 DOI: 10.1007/s00266-019-01521-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 10/05/2019] [Indexed: 12/26/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon T-cell, CD-30+/ALK lymphoma. Late (9 years) periprosthetic fluid (seroma) is the most common presentation (90% of the cases). A combination of textured breast implant, bacterial contamination, and genetic predisposition seems to be necessary for BIA-ALCL to occur. There are 35 million patients with implants in the world, and at the present moment, 573 cases of BIA-ALCL have been reported. The risk of developing BIA-ALCL in Australia varies from 1:2832 to 1:86,029, with texture grades 3 and 4 seeming to pose a higher risk than grades 2 and 1. NCCN has established guidelines for diagnosis and treatment, and early diagnosis is the key to cure. At an early stage and for the vast majority of patients, the treatment consists of capsulectomy and implant removal. However, at stages II to IV, a systemic treatment is warranted, including chemotherapy, radiotherapy (residual disease), and brentuximab vedotin. The majority of patients can be cured, and complete capsular removal is the most important factor. So far, 33 patients have died from BIA-ALCL worldwide, with deaths related to delay in diagnosis and treatment. Textured implants have been in the midst of the current implant crisis, and Biocell was recalled worldwide after the latest FDA update on the disease. At the present moment, no medical society or regulatory agency has recommended implant removal. It is about time that we start robust breast implant registries to determine risks. Besides, based on scientific criteria, we must consider all the benefits and risks associated with the available breast devices.Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Anne K Groth
- Brazilian Society of Plastic Surgery, Curitiba, Brazil.
- Plastic Surgery and Microsurgery Department, Erasto Gaertner Hospital, Curitiba, PR, Brazil.
- Positivo University Medical School, Curitiba, Brazil.
- , Curitiba, Brazil.
| | - Ruth Graf
- Brazilian Society of Plastic Surgery, Curitiba, Brazil
- Federal University of Parana, Curitiba, Brazil
- Pieta Medical Center, Rua Solimões 1175, Curitiba, PR, Brazil
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Abstract
BACKGROUND Breast ptosis is an inevitable consequence of gravity and time. Every breast tends to become ptotic in different shapes and degrees. Many surgical techniques were described to solve this problematic issue. The aim of this article is to describe a mastopexy technique used for grades 1 to 2 ptosis, "tuck-in" mastopexy technique. METHODS Keyhole pattern was used for skin markings. All the planned skin excision areas were de-epithelialized. Breast mound was elevated as a 1-piece flap with extensive subglandular dissection. Elevated breast flap was reshaped and repositioned. Skin incisions were sutured in 2 layers. RESULTS Seventeen patients were operated on with this technique; average follow-up time was 10.1 months. No major complications were seen. The results were pleasing for both the patients and the surgeon. CONCLUSIONS The "tuck-in" mastopexy technique uses breast mound as 1-piece flap, which has great vascularity from medial, superior, and lateral pedicles. Large areas of de-epithelialization facilitate reshaping and repositioning. It permits simultaneous or secondary breast augmentation with silicone gel implants. This easy-to-do technique has low complication rates and a short learning period.
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20
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Raj SD, Shurafa M, Shah Z, Raj KM, Fishman MDC, Dialani VM. Primary and Secondary Breast Lymphoma: Clinical, Pathologic, and Multimodality Imaging Review. Radiographics 2019; 39:610-625. [DOI: 10.1148/rg.2019180097] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Sean D. Raj
- From the Department of Radiology, Baylor University Medical Center, American Radiology Associates, 712 N Washington Ave, Dallas, TX 75246 (S.D.R., M.S., Z.S.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (K.M.R.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (M.D.C.F., V.M.D.)
| | - Mahmud Shurafa
- From the Department of Radiology, Baylor University Medical Center, American Radiology Associates, 712 N Washington Ave, Dallas, TX 75246 (S.D.R., M.S., Z.S.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (K.M.R.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (M.D.C.F., V.M.D.)
| | - Zeeshan Shah
- From the Department of Radiology, Baylor University Medical Center, American Radiology Associates, 712 N Washington Ave, Dallas, TX 75246 (S.D.R., M.S., Z.S.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (K.M.R.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (M.D.C.F., V.M.D.)
| | - Karuna M. Raj
- From the Department of Radiology, Baylor University Medical Center, American Radiology Associates, 712 N Washington Ave, Dallas, TX 75246 (S.D.R., M.S., Z.S.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (K.M.R.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (M.D.C.F., V.M.D.)
| | - Michael D. C. Fishman
- From the Department of Radiology, Baylor University Medical Center, American Radiology Associates, 712 N Washington Ave, Dallas, TX 75246 (S.D.R., M.S., Z.S.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (K.M.R.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (M.D.C.F., V.M.D.)
| | - Vandana M. Dialani
- From the Department of Radiology, Baylor University Medical Center, American Radiology Associates, 712 N Washington Ave, Dallas, TX 75246 (S.D.R., M.S., Z.S.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (K.M.R.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (M.D.C.F., V.M.D.)
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Achieving Reliable Diagnosis in Late Breast Implant Seromas: From Reactive to Anaplastic Large Cell Lymphoma. Plast Reconstr Surg 2019; 143:15S-22S. [PMID: 30817552 DOI: 10.1097/prs.0000000000005565] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Late onset of fluid collection surrounding breast implants may represent a serious issue when considering the possibility of breast implant-associated anaplastic large cell lymphoma, a newly recognized type of T-cell malignancy. However, many other factors, including trauma and infections, may be implicated in the formation of non-neoplastic periprosthetic delayed effusions. An appropriate management of late seromas, consisting of ultrasound-guided fluid drainage, cultures, cytology, and immunocytochemical and T-cell clonality studies, should be performed to achieve a correct and prompt diagnosis of breast implant-associated anaplastic large cell lymphoma. Criticisms in the diagnosis of late peri-implant effusions are here discussed in detail.
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Clinicopathologic Features and Prognostic Impact of Lymph Node Involvement in Patients With Breast Implant-associated Anaplastic Large Cell Lymphoma. Am J Surg Pathol 2019; 42:293-305. [PMID: 29194092 DOI: 10.1097/pas.0000000000000985] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) is a rare T-cell lymphoma that arises around breast implants. Most patients manifest with periprosthetic effusion, whereas a subset of patients develops a tumor mass or lymph node involvement (LNI). The aim of this study is to describe the pathologic features of lymph nodes from patients with BI-ALCL and assess the prognostic impact of LNI. Clinical findings and histopathologic features of lymph nodes were assessed in 70 patients with BI-ALCL. LNI was defined by the histologic demonstration of ALCL in lymph nodes. Fourteen (20%) patients with BI-ALCL had LNI, all lymph nodes involved were regional, the most frequent were axillary (93%). The pattern of involvement was sinusoidal in 13 (92.9%) cases, often associated with perifollicular, interfollicular, and diffuse patterns. Two cases had Hodgkin-like patterns. The 5-year overall survival was 75% for patients with LNI and 97.9% for patients without LNI at presentation (P=0.003). Six of 49 (12.2%) of patients with tumor confined by the capsule had LNI, compared with LNI in 8/21 (38%) patients with tumor beyond the capsule. Most patients with LNI achieved complete remission after various therapeutic approaches. Two of 14 (14.3%) patients with LNI died of disease compared with 0/56 (0%) patients without LNI. Twenty percent of patients with BI-ALCL had LNI by lymphoma, most often in a sinusoidal pattern. We conclude that BI-ALCL beyond capsule is associated with a higher risk of LNI. Involvement of lymph nodes was associated with decreased overall survival. Misdiagnosis as Hodgkin lymphoma is a pitfall.
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Transcriptional analysis distinguishes breast implant-associated anaplastic large cell lymphoma from other peripheral T-cell lymphomas. Mod Pathol 2019; 32:216-230. [PMID: 30206415 DOI: 10.1038/s41379-018-0130-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 11/08/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma is a new provisional entity in the revised World Health Organization classification of lymphoid malignancies, the pathogenesis and cell of origin of which are still unknown. We performed gene expression profiling of microdissected breast implant-associated anaplastic large cell lymphoma samples and compared their transcriptional profiles with those previously obtained from normal T-cells and other peripheral T-cell lymphomas and validated expression of selected markers by immunohistochemistry. Our results indicate that most breast implant-associated anaplastic large cell lymphomas exhibit an activated CD4+ memory T-cell phenotype, which is associated with CD25 and FoxP3 expression. Gene ontology analyses revealed upregulation of genes involved in cell motility programs (e.g., CCR6, MET, HGF, CXCL14) in breast implant-associated anaplastic large cell lymphomas compared to normal CD4+ T-cells and upregulation of genes involved in myeloid cell differentiation (e.g., PPARg, JAK2, SPI-1, GAB2) and viral gene transcription (e.g., RPS10, RPL17, RPS29, RPL18A) compared to other types of peripheral T-cell lymphomas. Gene set enrichment analyses also revealed shared features between the molecular profiles of breast implant-associated anaplastic large cell lymphomas and other types of anaplastic large cell lymphomas, including downregulation of T-cell receptor signaling and STAT3 activation. Our findings provide novel insights into the biology of this rare disease and further evidence that breast implant-associated anaplastic large cell lymphoma represents a distinct peripheral T-cell lymphoma entity.
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Ramos-Gallardo G, Cuenca-Pardo J, Cardenas-Camarena L, Duran-Vega H, Rodríguez-Olivares E, Bayter-Marin JE, Levelier De Doig Alvear G, Vazquez G, Fontbona-Torres M, Galán-Suárez R, Guzman-Stein G, Guzmán-Padilla S, Echeverría-Roldán G, Silva-Gavarrete JF, Vallarta-Rodríguez A, Contreras-Bulnes L, Oaxaca-Escobar CG, Caravantes-Cortes I, Flores ME, Cowes-McGowen J, Maciel-Sosa ML, Delgado-Binasco R, Rincón-Rubio L. Is Latin America Ready to Identify Anaplastic Large Cell Lymphoma in Breast Implants Patients? Regional Encounter During the National Plastic Surgery Meeting in Cancun, Mexico. Aesthetic Plast Surg 2018; 42:1421-1428. [PMID: 29770862 DOI: 10.1007/s00266-018-1148-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 04/28/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Anaplastic large cell lymphoma associated with breast implants is receiving increased attention. Most cases have been reported in Europe, North America (USA and Canada), Australia and New Zealand. Fewer cases have been reported in Latin America (including Mexico), Africa and Asia. METHODS This report was delivered during our national plastic surgery meeting in Cancun in May 2017. Before the meeting, two participants reviewed the literature. The review was performed using the following information sources: PubMed, Embase, Cochrane, Fisterra, Google Scholar and LILACS, with entries from 1980 to August 2015 in several languages (English, Spanish, French and Portuguese). The results were revealed during the meeting to the other participants. The consensus was divided into two parts. The first part included an open-ended question regarding the incidence and prevalence of the problem. The second part included clinical scenarios with different items that were rated by the participants. After this activity, accordance among the responses was evaluated. RESULTS Seven cases were reported during the meeting (3 from Mexico, 3 from Chile and 1 from Argentina). Fifty percent of the participants reported consulting with guidelines and clinical centers to help with potential cases. Most agreed that further studies must be done in cases of chronic seroma where the capsule plays an important role. DISCUSSION A current debate exists about the incidence of this problem in Latin America because we did not report the same number of cases as Europe, Australia or North America. More studies are required to determine the differences among reports in Latin America. CONCLUSION Most representatives agreed that further studies must be done. Concern is increasing, and the problem is known. Other factors involved may be considered, and the problem must not be ignored. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Guillermo Ramos-Gallardo
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico.
| | - Jesus Cuenca-Pardo
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Lazaro Cardenas-Camarena
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Hector Duran-Vega
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Eugenio Rodríguez-Olivares
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Jorge Enrique Bayter-Marin
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Gerardo Levelier De Doig Alvear
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Guillermo Vazquez
- Sociedad Argentina de Cirugía Plástica Estética y Reconstructiva, Federación Iberolatinoamericana de Cirugía Plástica, Buenos Aires, Argentina
| | | | - Ricardo Galán-Suárez
- Sociedad Colombiana de Cirugía Plástica Estética y Reconstructiva, Cartagena, Colombia
| | - Gabriela Guzman-Stein
- Asociación Costarricense de Cirugía Plástica Estética y Reconstructiva, San José, Costa Rica
| | - Sergio Guzmán-Padilla
- Sociedad Dominicana de Cirugía Plástica Reconstructiva y Estética, Punta Cana, Dominican Republic
| | | | | | - Alfonso Vallarta-Rodríguez
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Livia Contreras-Bulnes
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Carlos Guillemro Oaxaca-Escobar
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Isabel Caravantes-Cortes
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | | | - Jorge Cowes-McGowen
- Asociación Panameña de Cirugía Plástica Estética y Reconstructiva, Panama City, Panama
| | - María Liz Maciel-Sosa
- Sociedad Paraguaya de Cirugía Plástica Estética y Reconstructiva, Asunción, Paraguay
| | | | - Linda Rincón-Rubio
- Sociedad Venezolana de Cirugía Plástica Estética, Reconstructiva y Maxilofacial, Caracas, Venezuela
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Macrotextured Breast Implants with Defined Steps to Minimize Bacterial Contamination around the Device: Experience in 42,000 Implants. Plast Reconstr Surg 2018; 142:412e-413e. [PMID: 29965912 DOI: 10.1097/prs.0000000000004654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Santanelli di Pompeo F, Sorotos M. EURAPS Editorial: BIA-ALCL, a brief overview. J Plast Reconstr Aesthet Surg 2018; 71:785-787. [PMID: 29776552 DOI: 10.1016/j.bjps.2018.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Fabio Santanelli di Pompeo
- EURAPS European Association of Plastic Surgeons, Rome, Italy; "Sapienza" University of Rome, School of Medicine and Psychology, School program in Plastic Reconstructive and Aesthetic Surgery, Rome, Italy; Plastic Surgery Unit, Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189 Rome, Italy
| | - Michail Sorotos
- Plastic Surgery Unit, Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189 Rome, Italy.
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Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon neoplasia occurring in women with either cosmetic or reconstructive breast implants. The actual knowledge about BIA-ALCL deriving from the literature presents several limits, and it remains difficult to make inferences about BIA-ALCL epidemiology, cause, and pathogenesis. This is the reason why the authors decided to organize an evidence-based consensus conference during the Maurizio Bruno Nava (MBN 2016) Aesthetic Breast Meeting held in Milan in December of 2016. Twenty key opinion leaders in the field of plastic surgery from all over the world have been invited to express and discuss their opinion about some key questions on BIA-ALCL, trying to reach a consensus about BIA-ALCL cause, pathogenesis, diagnosis, and treatment in light of the actual best evidence.
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Mendonça Munhoz A, Santanelli di Pompeo F, De Mezerville R. Nanotechnology, nanosurfaces and silicone gel breast implants: current aspects. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2017; 4:99-113. [PMID: 29250575 PMCID: PMC5727455 DOI: 10.1080/23320885.2017.1407658] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/16/2017] [Indexed: 02/03/2023]
Abstract
Nanotechnology is defined as the design of products that interact with biological systems on the nanoscopic scale. Creating a controlled nanotexture and understanding the ways in which surface properties impact inflammatory response is of the utmost significance in designing implants that can provide satisfactory outcomes.
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Affiliation(s)
- Alexandre Mendonça Munhoz
- Plastic Surgery Division, Hospital Sírio-LibanêsSão PauloBrazil.,Breast Surgery Group, Plastic Surgery Division, University of São Paulo School of MedicineSão PauloBrazil
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Kaartinen I, Sunela K, Alanko J, Hukkinen K, Karjalainen-Lindsberg ML, Svarvar C. Breast implant-associated anaplastic large cell lymphoma – From diagnosis to treatment. Eur J Surg Oncol 2017. [DOI: 10.1016/j.ejso.2017.05.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Di Napoli A, Pepe G, Giarnieri E, Cippitelli C, Bonifacino A, Mattei M, Martelli M, Falasca C, Cox MC, Santino I, Giovagnoli MR. Cytological diagnostic features of late breast implant seromas: From reactive to anaplastic large cell lymphoma. PLoS One 2017; 12:e0181097. [PMID: 28715445 PMCID: PMC5513491 DOI: 10.1371/journal.pone.0181097] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/26/2017] [Indexed: 11/18/2022] Open
Abstract
Late breast implant seroma may be the presentation of a breast implant-associated anaplastic large cell lymphoma (BI-ALCL), which claims for a prompt recognition. However, BI-ALCL diagnosis on fine-needle aspiration (FNA) might be challenging for pathologists lacking experience with peri-implant breast effusions. Sixty-seven late breast implant seromas collected by FNA from 50 patients were evaluated by Papanicolaou smear stain and immunocytochemistry on cell blocks. A diagnostic algorithm based on the cellular composition, cell morphology and percentage of CD30+ cells was developed. Histological evaluation of the corresponding peri-prosthetic capsules was also performed. Most of the effusions (91% of the samples) were classified as reactive and 9% as BI-ALCL. In the BI-ALCL cases, medium-to-large atypical cells expressing CD30 represented more than 70% of the cellularity, whereas in in the reactive effusions CD30+ elements were extremely rare (<5%) and consisted of non-atypical elements. The reactive effusions were categorized into three patterns: i) acute infiltrate with prominent neutrophilic component (33% of the samples); ii) mixed infiltrate characterized by a variable number of neutrophils, lymphocytes and macrophages (30% of the samples); iii) chronic infiltrate composed predominantly of T lymphocytes or macrophages with only sporadic granulocytes (37% of the samples). The inflammatory cytological patterns were consistent with the histology of the corresponding capsules. Our results indicate that cytological analysis of late breast implant effusions, supported by the knowledge of the heterogeneous cytomorphological spectrum of late seromas, is a valuable approach for the early recognition of BI-ALCL.
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MESH Headings
- Adult
- Aged
- Antigens, CD/metabolism
- Antigens, Differentiation, Myelomonocytic/metabolism
- Breast Implantation
- Breast Neoplasms/pathology
- CD3 Complex/metabolism
- Female
- Gene Rearrangement
- Humans
- Ki-1 Antigen/metabolism
- Klebsiella oxytoca/isolation & purification
- Lymphocytes/cytology
- Lymphocytes/metabolism
- Lymphoma, Large-Cell, Anaplastic/pathology
- Macrophages/cytology
- Macrophages/metabolism
- Middle Aged
- Neutrophils/cytology
- Neutrophils/metabolism
- Pseudomonas aeruginosa/isolation & purification
- Receptors, Antigen, T-Cell, gamma-delta/genetics
- Receptors, Antigen, T-Cell, gamma-delta/metabolism
- Seroma/diagnosis
- Seroma/microbiology
- Serratia marcescens/isolation & purification
- Staphylococcus aureus/isolation & purification
- Young Adult
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Affiliation(s)
- Arianna Di Napoli
- Department of Clinical and Molecular Medicine, Sapienza University, Pathology Unit, Sant'Andrea Hospital, Roma, Italy
- * E-mail:
| | - Giuseppina Pepe
- Department of Clinical and Molecular Medicine, Sapienza University, Pathology Unit, Sant'Andrea Hospital, Roma, Italy
| | - Enrico Giarnieri
- Department of Clinical and Molecular Medicine, Sapienza University, Cytology Unit, Sant'Andrea Hospital, Roma, Italy
| | - Claudia Cippitelli
- Department of Clinical and Molecular Medicine, Sapienza University, Pathology Unit, Sant'Andrea Hospital, Roma, Italy
| | | | - Mauro Mattei
- Breast Unit, Sant’Andrea Hospital, Sapienza University, Roma, Italy
| | - Maurizio Martelli
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Carlo Falasca
- Department of Clinical and Molecular Medicine, Sapienza University, Cytology Unit, Sant'Andrea Hospital, Roma, Italy
| | | | - Iolanda Santino
- Department of Clinical and Molecular Medicine, Sapienza University, Microbiology Unit, Sant'Andrea Hospital, Roma, Italy
| | - Maria Rosaria Giovagnoli
- Department of Clinical and Molecular Medicine, Sapienza University, Cytology Unit, Sant'Andrea Hospital, Roma, Italy
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Ramos-Gallardo G, Cuenca-Pardo J, Rodríguez-Olivares E, Iribarren-Moreno R, Contreras-Bulnes L, Vallarta-Rodríguez A, Kalixto-Sanchez M, Hernández C, Ceja-Martinez R, Torres-Rivero C. Breast Implant and Anaplastic Large Cell Lymphoma Meta-Analysis. J INVEST SURG 2016; 30:56-65. [DOI: 10.1080/08941939.2016.1215576] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dinets A, Unukovych D, Khrapach V, Zakhartseva O, Sulik V, Kaminskyi E, Khrapach O, Meloyan A, Zakhartseva L, Mishalov V. An unusual case of a ruptured Poly Implant Prothèse breast implant associated with xanthoma. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2016; 3:11-5. [PMID: 27583262 PMCID: PMC4996062 DOI: 10.3109/23320885.2016.1153974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 02/10/2016] [Indexed: 11/13/2022]
Abstract
A suspicious breast mass was intra-operatively found in a female patient previously operated for breast augmentation with the Poly Implant Prothèse (PIP) implants. The neoplasm was verified as xanthoma and an asymptomatic microrupture of PIP was also detected. This report discusses possible association of breast xanthoma with PIP implant rupture.
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Affiliation(s)
- Andrii Dinets
- Department of Surgery #4, Bogomolets National Medical University, Kiev, Ukraine; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Dmytro Unukovych
- Department of Surgery #4, Bogomolets National Medical University, Kiev, Ukraine; Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Vasyl Khrapach
- Department of Surgery #4, Bogomolets National Medical University , Kiev , Ukraine
| | - Olga Zakhartseva
- Department of Surgery #4, Bogomolets National Medical University , Kiev , Ukraine
| | - Volodymyr Sulik
- Department of Surgery #4, Bogomolets National Medical University , Kiev , Ukraine
| | - Edgar Kaminskyi
- Department of Plastic Surgery, Harmony Hospital , Kiev , Ukraine
| | - Olexandr Khrapach
- Department of Surgery #4, Bogomolets National Medical University , Kiev , Ukraine
| | - Ani Meloyan
- Department of Oncology-Pathology, Karolinska Institutet , Stockholm , Sweden
| | - Lubov Zakhartseva
- Department of Pathology, Kyiv City Teaching Oncology Center , Kiev , Ukraine
| | - Volodymyr Mishalov
- Department of Surgery #4, Bogomolets National Medical University , Kiev , Ukraine
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Characterization of Breast Implant Surfaces, Shapes, and Biomechanics: A Comparison of High Cohesive Anatomically Shaped Textured Silicone, Breast Implants from Three Different Manufacturers. Aesthetic Plast Surg 2016; 40:89-97. [PMID: 26746882 DOI: 10.1007/s00266-015-0603-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED Several companies offer anatomically shaped breast implants but differences among manufacturers are often misunderstood. The shell texture is a crucial parameter for anatomically shaped implants to prevent rotation and to decrease the risk of capsular contracture, even though concerns have recently been raised concerning the complications associated with textured breast implants. The aim of this study was to characterize differences in terms of texture, cell adhesion, shape, and stiffness between some commonly used anatomically shaped implants from three different manufacturers. METHODS Five commercially available anatomically shaped breast implants from 3 different manufacturers (Allergan, Mentor, and Sebbin) were used. Scanning electron microscopy, X-ray microtomography, and scanning mechanical microscopy were used to characterize the shell texture. Human fibroblast adhesion onto the shells was evaluated. 3D models of the implants were obtained using CT-scan acquisitions to analyze their shape. Implant stiffness was evaluated using a tractiometer. RESULTS Major differences were observed in the topography of the textures of the shells, but this was not conveyed by a statistically significant fibroblast adhesion difference. However, fibroblasts adhered better on anatomically shaped textured implants than on smooth implants (p < 0.01). Our work pointed out differences in the Biocell® texture in comparison with older studies. The 3D analysis showed significant shape differences between the anatomically shaped implants of the 3 companies, despite similar dimensions. Implant stiffness was comparable among the 3 brands. CONCLUSIONS Each texture had its specific topography, and this work is the first description of Sebbin anatomic breast implant texturation. Moreover, major discrepancies were found in the analysis of the Biocell® texture when comparing our results with previous reports. These differences may have clinical implications and are discussed. This study also highlighted major shape differences among breast implants from different manufacturers, which is quite counterintuitive. The clinical impact of these differences however needs further investigation. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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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