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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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A Spectrum of Disease: Breast Implant-Associated Anaplastic Large Cell Lymphoma, Atypicals, and Other Implant Associations. Clin Plast Surg 2023; 50:249-257. [PMID: 36813403 DOI: 10.1016/j.cps.2022.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon and emerging malignancy caused by textured breast implants. The most common patient presentation is delayed seromas, other presentations include breast asymmetry, overlying skin rashes, palpable masses, lymphadenopathy, and capsular contracture. Confirmed diagnoses should receive lymphoma oncology consultation, multidisciplinary evaluation, and PET-CT or CT scan evaluation prior to surgical treatment. Disease confined to the capsule is curable in the majority of patients with complete surgical resection. BIA-ALCL is now recognized as one disease among a spectrum of inflammatory mediated malignancies which include implant-associated squamous cell carcinoma and B cell lymphoma.
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3
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Santanelli di Pompeo F, Sorotos M, Clemens MW, Paolini G, Anibaldi P, Davoli M, Baglio G, Pinnarelli L, Ferranti M, Cerza F, Cicala SD, Firmani G. Comment on "Reply to Mortality Rate in Breast Implant Surgery: Is an Additional Procedure Worthwhile to Mitigate BIA-ALCL Risk". Aesthetic Plast Surg 2023; 47:930-933. [PMID: 36991257 DOI: 10.1007/s00266-023-03324-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/09/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Fabio Santanelli di Pompeo
- Faculty of Medicine and Psychology, Sapienza University of Rome, Azienda Ospedaliera Sant'Andrea - U.O.D. Chirurgia Plastica, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.
- Sant'Andrea University Hospital, Rome, Italy.
| | - Michail Sorotos
- Faculty of Medicine and Psychology, Sapienza University of Rome, Azienda Ospedaliera Sant'Andrea - U.O.D. Chirurgia Plastica, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
- Sant'Andrea University Hospital, Rome, Italy
| | - Mark W Clemens
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Guido Paolini
- Faculty of Medicine and Psychology, Sapienza University of Rome, Azienda Ospedaliera Sant'Andrea - U.O.D. Chirurgia Plastica, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
- Sant'Andrea University Hospital, Rome, Italy
| | | | - Marina Davoli
- Lazio Regional Health Service, Rome, Italy
- Italian National Agency for Regional Healthcare Services (AGENAS), Italian Ministry of Health, Rome, Italy
| | - Giovanni Baglio
- Italian National Agency for Regional Healthcare Services (AGENAS), Italian Ministry of Health, Rome, Italy
| | | | | | - Francesco Cerza
- Italian National Agency for Regional Healthcare Services (AGENAS), Italian Ministry of Health, Rome, Italy
| | - Stefano Domenico Cicala
- Italian National Agency for Regional Healthcare Services (AGENAS), Italian Ministry of Health, Rome, Italy
| | - Guido Firmani
- Faculty of Medicine and Psychology, Sapienza University of Rome, Azienda Ospedaliera Sant'Andrea - U.O.D. Chirurgia Plastica, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
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4
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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, Panagiotakos D, Swanson EC, Turner SD, Firmani G, Sorotos M. Response to: What Is Missing From the 2022 Practice Recommendation Updates From the World Consensus Conference on BIA-ALCL? Aesthet Surg J 2023; 43:NP138-NP140. [PMID: 36419172 DOI: 10.1093/asj/sjac305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Fabio Santanelli di Pompeo
- Full professor of plastic surgery, Faculty of Medicine and Psychology, Sapienza University of Rome, Department NESMOS, Sant'Andrea Hospital, Rome, Italy
| | - Mark W Clemens
- Associate professor of plastic surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, and a breast surgery section editor for Aesthetic Surgery Journal
| | - Michael Atlan
- Associate professor of plastic surgery, Aesthetic Plastic Reconstructive Unit/CHU TENON PARIS - APHP, Université Pierre et Marie Curie, Paris, France. Université Pierre et Marie Curie, UPMC PARIS VI, Paris, France
| | | | - Peter G Cordeiro
- Professor of surgery, Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Daphne De Jong
- Full professor of pathology, Amsterdam UMC-Vrije Universiteit Amsterdam, Department of Pathology and Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Arianna Di Napoli
- Associate professor of pathology, Pathology Unit, Department of Clinical and Molecular Medicine, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Dennis Hammond
- Plastic surgeon in private practice in Grand Rapids, MI, USA
| | - Cara L Haymaker
- Assistant professor of immunology, Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven M Horwitz
- Professor of medicine, Lymphoma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Kelly Hunt
- Professor of surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Lennox
- Division head, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia, Canada, and a clinical editor for Aesthetic Surgery Journal
| | | | - Roberto N Miranda
- Associate professor of hematopathology, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexandre M Munhoz
- Professor of plastic surgery, Plastic Surgery Department, Hospital Moriah, Hospital Sírio-Libanês, Higienópolis, São Paulo, Brazil
| | - Demosthenes Panagiotakos
- Professor in biostatistics, research methods, and epidemiology, School of Health Sciences and Education, Harokopio University in Athens, Athens, Greece
| | | | - Suzanne D Turner
- Professor of cellular and molecular tumour biology, Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Guido Firmani
- Plastic surgery resident, Faculty of Medicine and Psychology, Sapienza University of Rome, Department NESMOS, Sant'Andrea Hospital, Rome, Italy
| | - Michail Sorotos
- Assistant professor of plastic surgery, Faculty of Medicine and Psychology, Sapienza University of Rome, Department NESMOS, Sant'Andrea Hospital, Rome, Italy
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5
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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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6
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Clemens MW. Commentary on: Management of Asymptomatic Patients With Textured Breast Implants: A Survey Analysis of Members of The Aesthetic Society. Aesthet Surg J 2022; 42:367-369. [PMID: 33743007 DOI: 10.1093/asj/sjab141] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mark W Clemens
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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7
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Tevis SE, Hunt KK, Miranda RN, Lange C, Pinnix CC, Iyer S, Butler CE, Clemens MW. Breast Implant-associated Anaplastic Large Cell Lymphoma: A Prospective Series of 52 Patients. Ann Surg 2022; 275:e245-e249. [PMID: 32568749 DOI: 10.1097/sla.0000000000004035] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to evaluate patients at a single academic institution in a prospective manner to report patient presentation, clinical course, treatment, and outcomes in breast implant ALCL patients. BACKGROUND Breast implant-associated anaplastic large cell lymphoma (breast implant ALCL) is an uncommon T cell lymphoma, which is associated with textured surface breast implants. The disease has received increasing attention over the last 20 years. Previous retrospective studies have begun to outline the clinical course of breast implant ALCL. METHODS We prospectively followed women with cytologically proven breast implant ALCL from 2014 to 2019. Demographic, clinical, treatment, and outcome data were collected and descriptive statistics were performed on variables of interest. RESULTS We identified 52 women with pathologically confirmed breast implant ALCL. Implants were placed for augmentation in 61.5% of women and reconstruction in 36.5% of women. All of the 41 patients with known implant information had implants with textured surface. The majority of patients presented with delayed seroma (69.2%) and without systemic symptoms (86.5%). Most patients with staging information presented with Stage IA disease. Patient outcomes were excellent with 2 disease recurrence (3.8%) and all patients ultimately achieved complete remission. CONCLUSIONS Further evaluation of the prospective and growing database of patients with breast implant ALCL will further improve our understanding of the disease and its clinical course. Robust participation in the breast implant ALCL PROFILE registry will improve our knowledge of long-term outcomes after implant placement. Finally, increasing awareness for patients and providers will lead to earlier diagnosis and improved outcomes for patients.
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Affiliation(s)
- Sarah E Tevis
- Department of Surgery, University of Colorado, Aurora, CO
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, TX
| | - Roberto N Miranda
- Department of Hematopathology, MD Anderson Cancer Center, Houston, TX
| | - Caitlin Lange
- Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX
| | - Chelsea C Pinnix
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | | | - Charles E Butler
- Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX
| | - Mark W Clemens
- Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX
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8
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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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9
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Park JO, Webb CE, Temple-Oberle CF. Supporting Women's BIA-ALCL Decision-making: Role of the Individual Consult in Empowering the Patient-Physician Team. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3843. [PMID: 34815911 PMCID: PMC8604015 DOI: 10.1097/gox.0000000000003843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is a T-cell non-Hodgkin's lymphoma and an uncommon risk of textured breast implants. Over the past decade, concern about BIA-ALCL has been increasing among both patients and surgeons. Patients are seeking a better understanding of their BIA-ALCL risk toward identifying a personalized care plan. This quality improvement project examines the value added by pairing group-based patient education seminars with one-on-one consults. METHODS Individual consults were held following educational group seminars. Consult field notes underwent qualitative thematic analysis. Themes were cross referenced against a quantitative chart review of patient BIA-ALCL prophylaxis decisions over time. RESULTS Four key themes were identified: weighing, perceiving, guiding, and supporting. Weighing considers the risk-benefit assessments patients make when weighing their BIA-ALCL risk. Perceiving describes the underlying psychosocial factors that frame patient perceptions of BIA-ALCL risk. Guiding presents the levels of guidance that patients require when making BIA-ALCL prophylaxis decisions. Supporting explores the therapeutic value of the individual consult. Ultimately, 41% of post-seminar consult attendees sought explantation, compared with 4% among patients who did not participate in this program (P < 0.001). CONCLUSIONS Key lessons include the following: (1) patients weigh BIA-ALCL risk against perceived surgical risks and the value of their reconstruction; (2) patients can benefit from a personalized balance of autonomy and surgeon guidance when selecting a BIA-ALCL prevention plan; (3) surgeons should seek to understand the psychosocial factors that may underlie patient perceptions of BIA-ALCL risk; and (4) individual consults can be therapeutic and help strengthen the patient-surgeon relationship.
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Affiliation(s)
- Jade O. Park
- From Undergraduate Medical Education, University of Calgary, Calgary, Alberta, Canada
| | - Carmen E. Webb
- Departments of Surgery and Oncology, University of Calgary, Calgary, Alberta, Canada
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10
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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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11
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Nelson JA, McCarthy C, Dabic S, Polanco T, Chilov M, Mehrara BJ, Disa JJ. BIA-ALCL and Textured Breast Implants: A Systematic Review of Evidence Supporting Surgical Risk Management Strategies. Plast Reconstr Surg 2021; 147:7S-13S. [PMID: 33890875 PMCID: PMC9157223 DOI: 10.1097/prs.0000000000008040] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a significant public health concern for women with breast implants. The increase in incidence rates underscores the need for improved methods for risk reduction and risk management. The purpose of this study was to perform a systematic review to assess surgical risk reduction techniques and analyze communication/informed consent practices in patients with textured implants. METHODS A systematic review of the literature was conducted in PubMed (legacy), Embase (Embase.com), and Scopus with four search strategies including key terms centered around breast reconstruction and BIA-ALCL. RESULTS A total of 571 articles were identified, of which 276 were included in the final review after duplicates were removed. After review, no articles were determined to fit the inclusion criteria of demonstrating data-driven evidence of BIA-ALCL risk reduction through surgical measures, demonstrating a significant lack of data on risk reduction for BIA-ALCL. CONCLUSIONS Risk management for BIA-ALCL is an evolving area requiring additional investigation. Although removal of textured devices in asymptomatic patients is not currently recommended by the Food and Drug Administration, variability in estimates of risk has led many patients to electively replace these implants in an effort to decrease their risk of developing BIA-ALCL. To date, however, there is no evidence supporting the concept that replacing textured implants with smooth implants reduces risk for this disease. This information should be used to aid in the informed consent process for patients presenting to discuss management of textured breast implants.
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Affiliation(s)
- Jonas A Nelson
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Colleen McCarthy
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Stefan Dabic
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Thais Polanco
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Marina Chilov
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Babak J Mehrara
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Joseph J Disa
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
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Abstract
SUMMARY Proper management of symptomatic textured implant patients is critical to identify and treat associated oncologic disease. Textured surface breast implants were first introduced more than 50 years ago in an effort to decrease high rates of capsular contracture and implant malposition observed with first-generation smooth surface breast implants. Textured implants were dominant over smooth devices in the United States in the late 1990s, but they fell out of favor for newer-generation smooth implants, while texture remained the dominant selling implants worldwide until recently. A class I device recall by the US Food and Drug Administration in 2019 precipitated a removal of the highest selling implant worldwide, Allergan Biocell, due to a disproportionately increased risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Operative strategies, such as bacterial control at the time of textured implant insertion, have not been credibly shown to affect or prevent the future development of BIA-ALCL. BIA-ALCL patients require complete surgical excision of their disease, whereas textured implant patients who are otherwise asymptomatic do not require surgical removal. For suspicious cases, diagnostic testing with CD30 immunohistochemistry should be performed before any surgical intervention. Capsules are evaluated with 12 strategic regional biopsies in a standardized approach. If surgeons are revising or exchanging textured implants, they may reasonably consider a total capsulectomy, though this is not advocated by the Food and Drug Administration or national societies, and has not been shown to mitigate future risk of BIA-ALCL. The purpose of this article is to review data on and outcomes for textured surface implants, disease-associated risk, and the management strategy for revisionary surgery and device surveillance.
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13
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Elective Implant Removal and Replacement in Asymptomatic Aesthetic Patients with Textured Devices. Plast Reconstr Surg 2021; 147:14S-23S. [PMID: 33890876 DOI: 10.1097/prs.0000000000008041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
SUMMARY The management of patients with breast implants requires secondary procedures through the life of the implant, sometimes in the early postoperative period and more commonly many years after the initial surgery. In performing revisional procedures, removal and replacement of the implants is often required for a variety of reasons. With growing concerns of implant safety, implant exchange or removal with or without a capsulectomy has been increasingly requested by patients. In particular, textured breast implants have been under increased scrutiny secondary to their association with breast implant-associated anaplastic large cell lymphoma. Unfortunately, to date, there are no data and very little guidance as to the appropriate management of patients currently with textured implants as well as patients with a history of having had textured implants placed in the past. The surgeon must not only consider the appropriate management of patients with uncomplicated, asymptomatic textured devices but also consider the appropriate management when faced with another indication for revisional surgery and the need determine the appropriate course of action. An algorithm for the management of the explantation patient in general will be introduced in this review with a focus on the rationale, planning, and management of patients with an uncomplicated, asymptomatic textured implants.
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14
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DeCoster RC, Lynch EB, Bonaroti AR, Webster JM, Butterfield TA, Evers BM, Vasconez HC, Clemens MW. Breast Implant-associated Anaplastic Large Cell Lymphoma: An Evidence-based Systematic Review. Ann Surg 2021; 273:449-458. [PMID: 33234792 DOI: 10.1097/sla.0000000000004365] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This evidence-based systematic review synthesizes and critically appraises current clinical recommendations and advances in the diagnosis and treatment of BIA-ALCL. This review also aims to broaden physician awareness across diverse specialties, particularly among general practitioners, breast surgeons, surgical oncologists, and other clinicians who may encounter patients with breast implants in their practice. BACKGROUND BIA-ALCL is an emerging and treatable immune cell cancer definitively linked to textured-surface breast implants. Although the National Comprehensive Cancer Network (NCCN) consensus guidelines and other clinical recommendations have been established, the evidence supporting these guidelines has not been systematically studied. The purpose of this evidence-based systematic review is to synthesize and critically appraise current clinical guidelines and recommendations while highlighting advances in diagnosis and treatment and raising awareness for this emerging disease. METHODS This evidence-based systematic review evaluated primary research studies focusing on the diagnosis and treatment of BIA-ALCL that were published in PubMed, Google Scholar, and other scientific databases through March 2020. RESULTS AND CONCLUSIONS The clinical knowledge of BIA-ALCL has evolved rapidly over the last several years with major advances in diagnosis and treatment, including en bloc resection as the standard of care. Despite a limited number of high-quality clinical studies comprised mainly of Level III and Level V evidence, current evidence aligns with established NCCN consensus guidelines. When diagnosed and treated in accordance with NCCN guidelines, BIA-ALCL carries an excellent prognosis.
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Affiliation(s)
- Ryan C DeCoster
- Lucille P. Markey Cancer Center, University of Kentucky, Lexington, Kentucky
- Division of Plastic and Reconstructive Surgery, University of Kentucky, Lexington, Kentucky
| | - Evan B Lynch
- Division of Plastic and Reconstructive Surgery, University of Kentucky, Lexington, Kentucky
| | - Alisha R Bonaroti
- Division of Plastic and Reconstructive Surgery, University of Kentucky, Lexington, Kentucky
| | | | | | - Bernard Mark Evers
- Lucille P. Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Henry C Vasconez
- Division of Plastic and Reconstructive Surgery, University of Kentucky, Lexington, Kentucky
| | - Mark W Clemens
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Parham CS, Hanson SE, Butler CE, Calobrace MB, Hollrah R, Macgregor T, Clemens MW. Advising patients about breast implant associated anaplastic large cell lymphoma. Gland Surg 2021; 10:417-429. [PMID: 33634000 PMCID: PMC7882310 DOI: 10.21037/gs.2020.03.06] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/28/2020] [Indexed: 11/06/2022]
Abstract
The United States Food and Drug Administration (FDA) recently recognized the necessity for improved patient education and public awareness of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). BIA-ALCL is an uncommon T-cell lymphoma that can arise years after placement of a textured breast implant or tissue expander. Patients and providers would greatly benefit from a broader awareness of BIA-ALCL and how it presents with both common and rare symptoms. Disease awareness can be improved with specific steps moving forward. This includes improved counseling about annual recommendations from the FDA, standard of care guidelines, current estimates of disease prevalence, and manufacturer-specific risk for developing the malignancy. Informed consent for implant-based breast surgery should include a discussion of BIA-ALCL, symptoms, inherent risks and alternatives. Consideration should be given for reasonable efforts to retroactively contact patients with textured implants to inform them of recent regulatory actions as well as the risk of developing the disease and the signs and symptoms to watch for. Where risk can be reduced, all steps should be taken to ensure patient safety. In keeping with our commitment to patient safety, the strategies moving forward for implant-based breast surgery should be marked by patient awareness, physician vigilance, and defined by evidence-based diagnosis and treatment.
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Affiliation(s)
- Christopher S. Parham
- Department of Surgery, Division of Plastic Surgery, Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Summer E. Hanson
- Department of Plastic Surgery, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Charles E. Butler
- Department of Plastic Surgery, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - M. Bradley Calobrace
- CaloAesthetics Plastic Surgery Center; Clinical Faculty Member, Divisions of Plastic Surgery, University of Louisville and University of Kentucky, Louisville and Lexington, KY, USA
| | | | | | - Mark W. Clemens
- Department of Plastic Surgery, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
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Stack A, Ali N, Khan N. Breast Implant-associated Anaplastic Large Cell Lymphoma: A Review with Emphasis on the Role of Brentuximab Vedotin. JOURNAL OF CELLULAR IMMUNOLOGY 2020; 2:80-89. [PMID: 32914146 PMCID: PMC7480932 DOI: 10.33696/immunology.2.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Breast implant-associated anaplastic large cell lymphoma is a recently recognized complication of textured breast implants. It typically presents as unilateral peri-implant swelling approximately 7-10 years after implantation. While the course is usually indolent, breast implant-associated anaplastic large cell lymphoma may form a locally invasive mass and metastasize to regional lymph nodes or beyond to distant sites. Surgical excision has been well established as the standard of care for localized disease; however, guidelines directing management of advanced, recurrent or unresectable disease are based on limited and extrapolated evidence. The CD30-targeting immunoconjugate, brentuximab vedotin, has been utilized in this setting, typically in combination with chemotherapy. We recently reported a patient with unresectable breast implant-associated anaplastic large cell lymphoma who was treated with brentuximab vedotin monotherapy and has now sustained complete remission for 2.6 years. Herein, we provide an up-to-date review of the epidemiology, pathogenesis, clinical features, diagnosis and management of breast implant associated anaplastic large cell lymphoma with emphasis on the role of brentuximab vedotin.
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Affiliation(s)
- Anthony Stack
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA USA
| | - Nadia Ali
- Department of Medicine, section of Hematology, Temple University Hospital, Philadelphia, PA, USA
| | - Nadia Khan
- Department of Hematology and Oncology, Fox Chase Cancer Center, Philadelphia, PA USA
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Invited Discussion on: "What is the Evidence of Lymphoma in Patients with Prostheses Other Than Breast Implants?". Aesthetic Plast Surg 2020; 44:295-298. [PMID: 32006106 DOI: 10.1007/s00266-020-01629-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
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Clemens MW, DeCoster RC, Fairchild B, Bessonov AA, Santanelli di Pompeo F. Finding Consensus After Two Decades of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Semin Plast Surg 2019; 33:270-278. [PMID: 31632211 PMCID: PMC6797486 DOI: 10.1055/s-0039-1696998] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an emerging and indolent, but potentially fatal cancer of the immune system that can develop around textured-surface breast implants. The World Health Organization first recognized BIA-ALCL as a unique clinical entity in 2016. To date, over 600 confirmed cases have been reported worldwide. BIA-ALCL most commonly presents with disease confined to the capsule, as a seroma or a mass adjacent to the implant. While BIA-ALCL has a fairly indolent clinical course, with an excellent prognosis in early stage disease, disseminated cancer and death have also been reported. In this review, the authors focus on the early diagnosis and treatment, including reconstructing the breast following BIA-ALCL, and also discuss recently updated National Comprehensive Cancer Network guidelines. They also review the current epidemiology and risk factors associated with BIA-ALCL. Finally, they discuss important medicolegal considerations and the bioethics surrounding the continued use of textured-surface breast implants.
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Affiliation(s)
- Mark W. Clemens
- Department of Plastic Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Ryan C. DeCoster
- Lucille P. Markey Cancer Center, University of Kentucky, Lexington, Kentucky
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky
| | - Berry Fairchild
- Department of Surgery, University of Texas Health Science Center, Houston, Texas
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