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Ueno K, Sakata Y, Kawaji M, Miyasaka M, Asamura S. Late Hematoma After Feminizing Augmentation Mammoplasty Mimicking Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). EPLASTY 2024; 24:e32. [PMID: 38846510 PMCID: PMC11155343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
We report the case of an Asian transgender patient with late hematoma after feminizing mammoplasty. Bilateral silicone breast implants were inserted into the patient 25 years previously. The right breast gradually became swollen without any specific cause, along with erythema and pain. Positron emission tomography showed right axillary lymphadenopathy. The mass and the axillary lymph node were surgically removed. Pathologic examination of the excised specimen revealed only hematoma formation and inflammatory granulation. At follow-up at 6 months postoperatively there was no reformation of hematoma. The presented symptoms are similar to those of breast implant-associated anaplastic large cell lymphoma, so there can be difficulty in differentiating between these 2 complications. We compared the clinical characteristics between our case of late hematoma and reported breast implant-associated anaplastic large cell lymphoma after feminizing mammoplasty. Life-threatening breast implant-associated anaplastic large cell lymphoma should be ruled out from late hematoma according to the National Comprehensive Cancer Network screening guidelines.
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Affiliation(s)
- Kazuki Ueno
- Department of Plastic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-0012, Japan
| | - Yasuhiro Sakata
- Department of Plastic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-0012, Japan
| | - Mari Kawaji
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-0012, Japan
| | - Miwako Miyasaka
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-0012, Japan
| | - Shinichi Asamura
- Department of Plastic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-0012, Japan
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Flores T, Kerschbaumer C, Jaklin FJ, Rohrbacher A, Weber M, Luft M, Aspöck C, Ströbele B, Kitzwögerer M, Lumenta DB, Bergmeister KD, Schrögendorfer KF. Gram-Positive Bacteria Increase Breast Implant-Related Complications: Prospective Analysis of 100 Revised Implants. Plast Reconstr Surg 2024; 153:76-89. [PMID: 37036325 PMCID: PMC10729897 DOI: 10.1097/prs.0000000000010499] [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: 04/29/2022] [Accepted: 11/08/2022] [Indexed: 04/11/2023]
Abstract
BACKGROUND Breast implant-related complications can be reduced by strict antiseptic precautions during insertion, but bacteria can often be found on implant surfaces on the occasion of revision surgery. The authors prospectively analyzed the association of bacteria found on breast implant surfaces with implant-related complications in breast implant revision cases. METHODS The authors analyzed a total of 100 breast implant revisions in 66 patients between August of 2018 and January of 2021. Capsular swabs and capsular samples were taken intraoperatively. Analyses on the occurrence of bacteria and the occurrence of implant-related complications were performed. In addition, correlations between bacteria-contaminated breast implant surfaces and implant-related complications were performed. RESULTS Implant-related complications (perforation, rupture, capsular contraction) were observed in 42 implant sites: eight unilateral and 34 bilateral cases. In total, 16 swabs showed positive bacterial growth, 10 of which were associated with a breast implant-related complication (χ 2 = x, y, and z; P = 0.006). The most common implant-based complication at contaminated prosthetics was implant rupture. The association of contaminated breast implants and implant rupture was statistically significant. CONCLUSIONS The authors identified a correlation between implant complications and Gram-positive bacteria found on breast implant surfaces. The most common implant-based complication seen at simultaneously positive samples was implant rupture in 50% of the authors' cases. No capsular contraction or other complications were seen. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Tonatiuh Flores
- From the Karl Landsteiner University of Health Sciences
- Clinical Department of Plastic, Aesthetic and Reconstructive Surgery
| | - Celina Kerschbaumer
- From the Karl Landsteiner University of Health Sciences
- Clinical Department of Plastic, Aesthetic and Reconstructive Surgery
| | - Florian J. Jaklin
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna
| | | | - Michael Weber
- From the Karl Landsteiner University of Health Sciences
| | - Matthias Luft
- From the Karl Landsteiner University of Health Sciences
- Clinical Department of Plastic, Aesthetic and Reconstructive Surgery
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna
| | - Christoph Aspöck
- From the Karl Landsteiner University of Health Sciences
- Clinical Institute of Hygiene and Microbiology
| | - Barbara Ströbele
- From the Karl Landsteiner University of Health Sciences
- Clinical Institute of Hygiene and Microbiology
| | - Melitta Kitzwögerer
- From the Karl Landsteiner University of Health Sciences
- Clinical Institute for Pathology, University Clinic of St. Poelten
| | - David B. Lumenta
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz
| | - Konstantin D. Bergmeister
- From the Karl Landsteiner University of Health Sciences
- Clinical Department of Plastic, Aesthetic and Reconstructive Surgery
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna
| | - Klaus F. Schrögendorfer
- From the Karl Landsteiner University of Health Sciences
- Clinical Department of Plastic, Aesthetic and Reconstructive Surgery
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Mayeranoff P, Viault L, Misandeau Q, Paul M, Archer V, Tortolano L. [Medical information of patients with implants: Findings and prospects]. ANNALES PHARMACEUTIQUES FRANÇAISES 2024; 82:184-190. [PMID: 37778658 DOI: 10.1016/j.pharma.2023.09.006] [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: 08/10/2023] [Accepted: 09/27/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVES The main objective of this study was to assess the level of knowledge and information received by patients regarding their implants and to discuss the role of community pharmacists. METHODS A prospective survey was conducted in 3 pharmacies among patients presenting for various reasons. Firstly, on the same day, all patients visiting the pharmacy were asked if they had an implant. Secondly, patients with implants were offered a short survey consisting of 16 questions concerning the implant and the information received. RESULTS AND DISCUSSION The survey was conducted with 178 patients, among whom 11.4% had implants. The majority of them reported having osteoarticular, dental, or ophthalmic implants. Women were 67.1% of the cohort. None of the 178 patients with implants in the survey had complete information about their implant and its follow-up, which would enable optimal care and effective reporting in case of potential complications. CONCLUSION The majority of patients visiting the pharmacy had received limited or inadequate information about their implants. Community pharmacists, as local healthcare providers, in collaboration with hospitals, could play a crucial role in patient education. During the initial dispensing of postoperative treatments, pharmacists could inform and advise patients to enhance their patient journey.
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Affiliation(s)
- Pierre Mayeranoff
- Service pharmacie, Groupe hospitalier universitaire Henri-Mondor, 94000 Créteil, France
| | - Loriane Viault
- Service pharmacie, Groupe hospitalier universitaire Henri-Mondor, 94000 Créteil, France
| | - Quentin Misandeau
- Service pharmacie, Groupe hospitalier universitaire Henri-Mondor, 94000 Créteil, France
| | - Muriel Paul
- Service pharmacie, Groupe hospitalier universitaire Henri-Mondor, 94000 Créteil, France
| | - Valérie Archer
- Service pharmacie, Groupe hospitalier universitaire Henri-Mondor, 94000 Créteil, France
| | - Lionel Tortolano
- Service pharmacie, Groupe hospitalier universitaire Henri-Mondor, 94000 Créteil, France; Laboratoire matériaux et santé, université Paris-Saclay, 91400 Orsay, France.
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Gorgy A, Barone N, Nepon H, Dalfen J, Efanov JI, Davison P, Vorstenbosch J. Implant-based breast surgery and capsular formation: when, how and why?-a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:385. [PMID: 37970601 PMCID: PMC10632565 DOI: 10.21037/atm-23-131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/28/2023] [Indexed: 11/17/2023]
Abstract
Background and Objective Implant-based breast surgery is a common procedure for both reconstructive and aesthetic purposes. Breast implants, like any foreign object, trigger the formation of a capsule around them. While generally harmless, the capsule can undergo fibrotic changes leading to capsular contracture, which can negatively impact surgical outcomes and patient well-being. Additionally, rare but serious complications, such as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and capsule-associated squamous cell carcinoma, have been reported. This paper aims to review the physiology of capsular formation, identify factors contributing to capsule-related pathologies, and discuss their clinical implications. Methods A review of relevant literature was conducted by searching databases for articles published between inception and September 2022. The search included but not limited to terms such as "capsular formation" and "capsular contracture". Selected articles were critically analyzed to address the objectives of this review. Key Content and Findings Capsular formation involves interactions between the implant surface, surrounding tissues, and the immune system. Factors influencing pathological changes in the capsule include genetic predisposition, bacterial contamination, implant characteristics, and surgical techniques. Capsular contracture, characterized by tissue hardening, pain, and implant distortion, remains the most common complication. Rare but life-threatening conditions, such as BIA-ALCL and capsule-associated squamous cell carcinoma, necessitate vigilant monitoring and early detection. Conclusions Understanding the physiology of capsular formation and its associated pathologies is crucial for healthcare providers involved in implant-based breast surgery. Efforts should focus on minimizing the risk of capsular contracture through improved implant materials, surgical techniques, and infection prevention. The emergence of BIA-ALCL and capsule-associated squamous cell carcinoma underscores the importance of long-term surveillance and prompt diagnosis. Further research is needed to uncover underlying mechanisms and develop preventive measures and treatments for these complications. Enhancing our knowledge and clinical management of capsular formation will lead to safer and more successful outcomes in implant-based breast surgery.
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Affiliation(s)
- Andrew Gorgy
- Department of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Natasha Barone
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Hillary Nepon
- Department of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Jacquie Dalfen
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Johnny Ionut Efanov
- Plastic and Reconstructive Surgery Service, Department of Surgery, Centre Hospitalier de l’universite de Montreal, Montreal, Quebec, Canada
| | - Peter Davison
- Department of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Joshua Vorstenbosch
- Department of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada
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Keane GC, Keane AM, Diederich R, Kennard K, Duncavage EJ, Myckatyn TM. The evaluation of the delayed swollen breast in patients with a history of breast implants. Front Oncol 2023; 13:1174173. [PMID: 37476374 PMCID: PMC10354431 DOI: 10.3389/fonc.2023.1174173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023] Open
Abstract
Breast implants, whether placed for reconstructive or cosmetic purposes, are rarely lifetime devices. Rupture, resulting from compromised implant shell integrity, and capsular contracture caused by constriction of the specialized scar tissue that normally forms around breast implants, have long been recognized, and remain the leading causes of implant failure. It is apparent, however, that women with breast implants may also experience delayed breast swelling due to a range of etiologic factors. While a majority of delayed seromas associated with breast implants have a benign etiology, this presentation cannot be ignored without an adequate workup as malignancies such as breast implant associated anaplastic large cell lymphoma (BIA-ALCL), breast implant associated diffuse large B-cell lymphoma (BIA-DLBCL), and breast implant associated squamous cell carcinoma (BIA-SCC) can have a similar clinical presentation. Since these malignancies occur with sufficient frequency, and with sometimes lethal consequences, their existence must be recognized, and an appropriate diagnostic approach implemented. A multidisciplinary team that involves a plastic surgeon, radiologist, pathologist, and, as required, surgical and medical oncologists can expedite judicious care. Herein we review and further characterize conditions that can lead to delayed swelling around breast implants.
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Affiliation(s)
- Grace C. Keane
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO, United States
| | - Alexandra M. Keane
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO, United States
| | - Ryan Diederich
- MidAmerica Plastic Surgery, Glen Carbon, IL, United States
| | - Kaitlyn Kennard
- Division of Surgical Oncology, Washington University School of Medicine, Saint Louis, MO, United States
| | - Eric J. Duncavage
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, United States
| | - Terence M. Myckatyn
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO, United States
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Vorstenbosch J, Chu JJ, Ariyan CE, McCarthy CM, Disa JJ, Nelson JA. Clinical Implications and Management of Non-BIA-ALCL Breast Implant Capsular Pathology. Plast Reconstr Surg 2023; 151:20e-30e. [PMID: 36194076 PMCID: PMC9797444 DOI: 10.1097/prs.0000000000009780] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
SUMMARY The breast implant capsule is a dynamic structure that forms following the implantation of a device. Although normally benign, increased awareness of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) highlights that disease may arise from the capsule. BIA-ALCL presents as a late seroma or mass but explains few of the late seromas found in breast implant patients. To date, many of these seromas lack a clear cause and are often described as "idiopathic." Several benign and malignant breast implant capsular diseases can cause a late seroma or mass, including breast implant-associated squamous cell carcinoma. Similar to early reports of BIA-ALCL, these conditions are rare and largely limited to case reports or series. The purpose of this special topic is to present a narrative review highlighting capsular abnormalities that contribute to the formation of late seroma or mass in an attempt to broaden the differential diagnosis and help plastic surgeons identify the cause. Specifically, we review the presentation and management of BIA-ALCL, synovial metaplasia, capsular epithelialization, late hematoma, double capsule, breast cancer, squamous cell carcinoma, mesenchymal tumor, and B-cell lymphoma. Although rare, plastic surgeons should consider these capsular conditions as causes of late seromas and masses. Usually, these conditions may be diagnosed by following the National Comprehensive Cancer Network screening guidelines for BIA-ALCL. Thorough evaluation and workup of late seromas and masses may lead to improved characterization of these rare breast implant capsular conditions and improve our understanding of their pathophysiology and management.
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Affiliation(s)
- Joshua Vorstenbosch
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jacqueline J. Chu
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Charlotte E. Ariyan
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Colleen M. McCarthy
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph J. Disa
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonas A. Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Clinical recommendations for diagnosis and treatment according to current updated knowledge on BIA-ALCL. Breast 2022; 66:332-341. [PMID: 36502569 PMCID: PMC9763507 DOI: 10.1016/j.breast.2022.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/20/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
Shared strategies and correct information are essential to guide physicians in the management of such an uncommon disease as Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). A systematic review of the literature was performed to collect the most relevant evidence on BIA-ALCL reported cases. A panel of multidisciplinary experts discussed the scientific evidence on BIA-ALCL, and updated consensus recommendations were developed through the Delphi process. The lastest reported Italian incidence of BIA-ALCL is 3.5 per 100.000 implanted patients (95% CI, 1.36 to 5.78), and the disease counts over 1216 cases worldwide as of June 2022. The most common presentation symptom is a late onset seroma followed by a palpable breast mass. In the event of a suspicious case, ultrasound-guided fine-needle aspiration should be the first step in evaluation, followed by cytologic and immunohistochemical examination. In patients with confirmed diagnosis of BIA-ALCL confined to the capsule, the en-bloc capsulectomy should be performed, followed by immediate autologous reconstruction, while delayed reconstruction applies for disseminate disease or radically unresectable tumor. Nevertheless, a multidisciplinary team approach is essential for the correct management of this pathology.
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Muacevic A, Adler JR. Current Understanding of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Cureus 2022; 14:e30516. [PMID: 36420249 PMCID: PMC9678239 DOI: 10.7759/cureus.30516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/20/2022] [Indexed: 01/25/2023] Open
Abstract
Every year, breast implants are inserted worldwide for reconstructive or aesthetic reasons. Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rather uncommon type of T cell lymphoma that is positive for the CD30 biomarker. Despite being far more common than other primary breast lymphomas, BIA-ALCL has a very low incidence. Textured types of implants have been linked to almost all cases. The majority of patients have a favorable prognosis after the removal of implants and capsules. Nevertheless, the chance of a fatal outcome is higher with capsular invasion and tumor bulk. Although the exact cause of BIA-ALCL is unknown, it has been suggested that persistent infections or toxins related to the implants may play a role. Therefore, physicians must be aware of breast implants' rare but potentially significant side effects. Before surgery, patients with verified instances should be directed to a breast medical oncologist or lymphoma specialist for oncologic assessment. Total en-bloc capsulectomy, a surgical procedure that removes the implant and the surrounding capsule, is usually adequate. In other cases, a late diagnosis necessitates more invasive surgery and systemic therapies, which, while typically effective, have been linked to poor outcomes and even fatalities. Since it is a recently described entity and the "denominator" (i.e., the total number of breast implant procedures) is unknown, it is challenging to determine the risk of development. In this review, we hope to emphasize the elements of etiology, demography, clinical features, and current treatment approaches for BIA-ALCL. In doing so, we hope to increase the medical professional's knowledge of the recognition and treatment of BIA-ALCL.
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Conversion of Breast Implants into Natural Breast Reconstruction: Evaluating Lipofilled Mini Dorsi Flap. PLASTIC AND RECONSTRUCTIVE SURGERY - GLOBAL OPEN 2022; 10:e4450. [PMID: 35923995 PMCID: PMC9325333 DOI: 10.1097/gox.0000000000004450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 06/03/2022] [Indexed: 11/25/2022]
Abstract
Background: Autologous reconstruction techniques can provide a long-lasting natural breast reconstruction for patients. This study aimed to further investigate outcomes in the conversion of breast implant reconstruction into a lipofilled mini dorsi flap, focusing on reviewing its techniques, efficiency, and final results. Methods: Over 3 years, we performed a number of breast implant replacements via the lipofilled mini dorsi flap technique. The artificial implants were replaced to a deepithelized flap. The efficiency and tolerance of the technique were evaluated by the whole surgical team, and the achieved results were also analyzed by the patients in terms of postoperative pain, functional impact, and the softness of the reconstructed breast by comparing their prior condition to the lipofilled mini dorsi flap condition at least 9 months after operation. Results: Forty-seven consecutive operations were prospectively studied. The mean ± standard deviation volume of the removed implants was 348.66 ± 86.54 mL. The mean volume of fat injected was 284.13 ± 62.94 mL. The procedure’s average duration was 108.93 ± 17.65 minutes. The surgical team evaluated the results as very satisfactory in 32 cases (68.1%), satisfactory in 15 cases (31.9%), and moderately satisfactory or unsatisfactory in zero cases (0.0%). Eighteen patients (38.3%) evaluated their reconstruction as very good, while 20 patients (42.6%) considered their reconstruction as good, four (8.5%) as average, and zero (0.0%) as insufficient. Conclusion: According to our experience, the lipofilled mini dorsi flap is a simple, less invasive, and quick procedure to convert breast implants into natural breast reconstruction.
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Yaacobi DS, Shachar T, Olshinka A, Lvovsky A, Amir A, Ad-El D, Grush AE, Meshulam-Derazon S. Evolving Trends in Breast-Implant-Based Procedures in Israel: A National Survey. Semin Plast Surg 2022; 36:89-93. [DOI: 10.1055/s-0042-1747965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractRare reports linking textured breast implants to anaplastic large-cell lymphoma have generated controversies regarding their relative advantage over smooth implants. To evaluate trends in implant use in Israel, we sent a seven-item questionnaire to all active board-certified breast plastic surgeons in the country. About half responded. Approximately 60% of responders reported a moderate-to-considerable decrease in both the relative number of augmentation mammoplasty procedures and the use of implants during mastopexies in the last year. Nearly 40% had switched from textured to smooth implants to some extent. More than 40% still used textured implants for aesthetic procedures, and reconstructive procedures. Surgeons with more experience demonstrated a greater preference for smooth implants. The uncertainty regarding the safety of textured breast implants has led to a partial transition to the use of smoother implants and, importantly, to a general reduction in all breast-implant-based procedures.
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Affiliation(s)
- Dafna Shilo Yaacobi
- Department of Plastic Surgery and Burns, Rabin Medical Center – Beilinson Hospital, Petach Tikva; affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Shachar
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Asaf Olshinka
- Plastic Surgery & Burns Unit, Schneider Children's Medical Center of Israel, Petach Tikva, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Avraham Amir
- Department of Plastic Surgery and Burns, Rabin Medical Center – Beilinson Hospital, Petach Tikva; affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dean Ad-El
- Department of Plastic Surgery and Burns, Rabin Medical Center – Beilinson Hospital, Petach Tikva; affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andrew E. Grush
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Department of Surgery, Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Sagit Meshulam-Derazon
- Department of Plastic Surgery and Burns, Rabin Medical Center – Beilinson Hospital, Petach Tikva; affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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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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12
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Mehta-Shah N, Ghione P. An Updated Approach and Understanding of Breast Implant-Associated Anaplastic Large Cell Lymphoma. J Natl Compr Canc Netw 2022; 20:309-315. [PMID: 35276670 DOI: 10.6004/jnccn.2022.7004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/13/2022] [Indexed: 11/17/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare subtype of T-cell non-Hodgkin lymphoma that is usually localized to the fluid and capsule surrounding a breast implant. There have only been <1,000 cases and 36 deaths reported to date and the average patient presents 7 to 10 years following initial breast implant placement. Most patients present with delayed seromas, a breast mass, capsular abnormalities, lymphadenopathy, or cutaneous masses. Unlike other forms of non-Hodgkin lymphoma, most cases are cured with surgery alone. The challenge of BIA-ALCL surrounds its rarity-in regard to both its diagnosis as well as the limited available data to guide therapy for more advanced cases. Careful pathology evaluation to analyze both the fluid surrounding the capsule and the capsule itself is critical. Studies to identify which patients are at greater risk of development of this rare entity are ongoing.
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Affiliation(s)
- Neha Mehta-Shah
- 1Division of Oncology, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri; and
| | - Paola Ghione
- 2Division of Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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13
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Atiyeh B, Emsieh S. Breast Implant Illness (BII): Real Syndrome or a Social Media Phenomenon? A Narrative Review of the Literature. Aesthetic Plast Surg 2022; 46:43-57. [PMID: 34231017 DOI: 10.1007/s00266-021-02428-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/13/2021] [Indexed: 12/16/2022]
Abstract
Breast implant illness (BII) is a condition characterized by elusive diagnostic criteria and self-reported diverse disabling and distressing physical and psychological symptoms. With currently significant increase in public awareness, BII is perhaps becoming the most controversial subject in aesthetic and reconstructive breast surgery, generating heated debates between those who do not believe such a condition exists and those who demand its acceptance as a recognized diagnosis. Silicone incompatibility has been associated with "autoimmune/inflammatory syndrome induced by adjuvants" (ASIA syndrome) or Shoenfeld's syndrome. It is still unclear, however, whether BII symptoms would have occurred if no implants had been placed in the first place. The purpose of this literature review is to analyze critically the current state of scientific evidence related to this condition. Though the psychosomatic theory is most likely, the mechanism of BII symptoms is probably multifactorial. At present, BII being an underlying connective tissue disorder cannot be confirmed; moreover, whether improved aesthetic outcome and patient's overall satisfaction with the profile of their reconstructed or augmented breasts translate into decreased self-reported BII symptoms is still not well elucidated. 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)
- Bishara Atiyeh
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Saif Emsieh
- American University of Beirut Medical Center, Beirut, Lebanon.
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14
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Antmen E, Vrana NE, Hasirci V. The role of biomaterials and scaffolds in immune responses in regenerative medicine: macrophage phenotype modulation by biomaterial properties and scaffold architectures. Biomater Sci 2021; 9:8090-8110. [PMID: 34762077 DOI: 10.1039/d1bm00840d] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Scaffolds are an integral part of the regenerative medicine field. The contact of biomaterials with tissue, as was clearly observed over the years, induces immune reactions in a material and patient specific manner, where both surface and bulk properties of scaffolds, together with their 3D architecture, have a significant influence on the outcome. This review presents an overview of the reactions to the biomaterials with a specific focus on clinical complications with the implants in the context of immune reactions and an overview of the studies involving biomaterial properties and interactions with innate immune system cells. We emphasize the impact of these studies on scaffold selection and upscaling of microenvironments created by biomaterials from 2D to 3D using immune cell encapsulation, seeding in a 3D scaffold and co-culture with relevant tissue cells. 3D microenvironments are covered with a specific focus on innate cells since a large proportion of these studies used innate immune cells. Finally, the recent studies on the incorporation of adaptive immune cells in immunomodulatory systems are covered in this review. Biomaterial-immune cell interactions are a critical part of regenerative medicine applications. Current efforts in establishing the ground rules for such interactions following implantation can control immune response during all phases of inflammation. Thus, in the near future for complete functional recovery, tissue engineering and control over biomaterials must be considered at the first step of immune modulation and this review covers these interactions, which have remained elusive up to now.
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Affiliation(s)
- Ezgi Antmen
- BIOMATEN, Middle East Technical University, Center of Excellence in Biomaterials and Tissue Engineering, Ankara, Turkey.
| | - Nihal Engin Vrana
- SPARTHA Medical, 14B Rue de la Canardiere, Strasbourg Cedex 67100, France. .,INSERM Unité 1121 Biomaterials and Bioengineering, CRBS, 1 Rue Eugène Boeckel, Strasbourg Cedex 67000, France
| | - Vasif Hasirci
- BIOMATEN, Middle East Technical University, Center of Excellence in Biomaterials and Tissue Engineering, Ankara, Turkey. .,Biomaterials A&R Center, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.,Department of Medical Engineering, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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15
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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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16
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Everest S, Virk R, Gonzalez A. BIA-ALCL diagnosis on CytoLyt fixed ThinPrep, cell block and immunohistochemistry. Diagn Cytopathol 2021; 50:E1-E5. [PMID: 34623773 DOI: 10.1002/dc.24883] [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: 05/14/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/11/2022]
Abstract
Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is an emergent rare T cell non-Hodgkin lymphoma arising in association with a breast implant, particularly textured ones. Recent guidelines list cytopathological examination as the first essential step for diagnosis, routinely followed by CD30 immunohistochemistry (IHC) and flow cytometry (FC) for a T cell clone. The majority of BIA-ALCL literature regarding cytopathological evaluation describes morphology based on various preparation methods limited to cytospins and smears with the exception of at least one case report detailing cytomorphological and IHC findings on ThinPrep. This case report details initial diagnosis of BIA-ALCL rendered with CytoLyt prepared ThinPrep and cell block, including the specific antibodies used for IHC. The ThinPrep slide showed numerous singly dispersed large, atypical cells with abundant cytoplasm containing irregular nuclei with dispersed chromatin and prominent nucleoli in a background of macrophages, inflammatory cells and granular debris. TIA-1 and CD30 along with other T-cell markers, including specific antibodies, remains immunoreactive in tissue collected in CytoLyt solution. Cell size reduction, artifactual lymphoid cell aggregation and prominent nucleoli in benign and reactive conditions are among other ThinPrep cellular alterations pathologists should bear in mind.
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Affiliation(s)
- Sedef Everest
- Department of Pathology and Cell Biology, Columbia University, New York City, New York, USA
| | - Renu Virk
- Department of Pathology and Cell Biology, Columbia University, New York City, New York, USA
| | - Abel Gonzalez
- Department of Pathology and Cell Biology, Columbia University, New York City, New York, USA
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17
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Sanghera GK, Ingle A. Unilateral refractory late periprosthetic breast implant seroma and biofilm. ANZ J Surg 2021; 92:592-594. [PMID: 34352159 DOI: 10.1111/ans.17106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/06/2021] [Accepted: 07/17/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Gagandip K Sanghera
- Department of Plastic/Reconstructive Surgery, 27121 Townsville University Hospital, Townsville, Queensland, Australia
| | - Atul Ingle
- Department of Plastic/Reconstructive Surgery, 27121 Townsville University Hospital, Townsville, Queensland, Australia
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18
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Hallab NJ, Samelko L, Hammond D. Particulate Debris Released From Breast Implant Surfaces Is Highly Dependent on Implant Type. Aesthet Surg J 2021; 41:NP782-NP793. [PMID: 33564817 DOI: 10.1093/asj/sjab051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although breast implants (BIs) have never been safer, factors such as implant debris may influence complications such as chronic inflammation and illness such as ALCL (anaplastic large cell lymphoma). Do different types of BIs produce differential particulate debris? OBJECTIVES The aim of this study was to quantify, investigate, and characterize the size, amount, and material type of both loosely bound and adherent surface particles on 5 different surface types of commercial BIs. METHODS Surface particles from BIs of 5 surface types (n = 5/group), Biocell, Microcell, Siltex, Smooth, SmoothSilk, and Traditional-Smooth, were: (1) removed by a rinsing procedure and (2) removed with ultrapure adhesive carbon tabs. Particles were characterized (ASTM 1877-16) by scanning electron microscopy and energy-dispersive X-ray chemical analysis. RESULTS Particles rinsed from Biocell, Microcell and Siltex were <1 μm in diameter whereas SmoothSilk and Traditional-Smooth surfaces had median sizes >1 μm (range, 0.4-2.7 μm). The total mass of particles rinsed from the surfaces indicated Biocell had >5-fold more particulate compared with all other implants, and >30-fold more than SmoothSilk or Traditional-Smooth implants (>100-fold more for post-rinse adhesion analysis). Energy-dispersive X-ray analysis indicated that the particulate material for Biocell, Microcell, and Siltex was silicone (>50%), whereas particulates from SmoothSilk and Traditional-Smooth implants were predominantly carbon-based polymers, eg, polycarbonate-urethane, consistent with packaging (and were detected on all implant types). Generally, SmoothSilk and Traditional-Smooth implant groups released >10-fold fewer particles than Biocell, Microcell, and Siltex surfaces. Pilot ex vivo tissue analysis supported these findings. CONCLUSIONS Particulate debris released from BIs are highly dependent on the type of implant surface and are a likely key determinant of in vivo performance. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- Nadim James Hallab
- Department of Orthopedic Surgery, University of Illinois in Chicago, Chicago, IL, USA
| | - Lauryn Samelko
- Department of Orthopedic Surgery, University of Illinois in Chicago, Chicago, IL, USA
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19
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Cellular and Molecular Mechanisms of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Plast Reconstr Surg 2021; 147:30e-41e. [PMID: 33370049 DOI: 10.1097/prs.0000000000007423] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
SUMMARY Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an emerging and highly treatable cancer of the immune system that can form around textured-surface breast implants. Although the underlying cause has yet to be elucidated, an emerging theme-linking pathogenesis to a chronic inflammatory state-continues to dominate the current literature. Specifically, the combination of increasing mutation burden and chronic inflammation leads to aberrant T-cell clonal expansion. However, the impetus remains largely unknown. Proposed mechanisms include a lipopolysaccharide endotoxin response, oncogenic transformation related to viral infection, associated trauma to the breast pocket, particulate matter digestion by capsular macrophages, chronic allergic inflammation, and genetic susceptibility. The Janus kinase-signal transducer and activator of transcription 3 (JAK-STAT3) pathway is a major signaling pathway that regulates a variety of intracellular growth and survival processes. Constitutive activation of JAK-STAT3 has been implicated in several malignancies, including lymphomas, and has recently been identified as a potential key mediator in BIA-ALCL. The purpose of this article is to review the cellular and molecular mechanisms of BIA-ALCL with a focus on the role of oncogenic JAK-STAT3 signaling in BIA-ALCL tumorigenesis and progression. Selected experimental work from the authors' group on aberrant JAK-STAT3 signaling in BIA-ALCL is also included. The authors discuss how an inflammatory microenvironment may facilitate malignant transformation through the JAK-STAT3 pathway-highlighting its potential mechanistic role. The authors' hope is that further investigation of this signaling pathway will reveal avenues for using JAK-STAT3 signaling as a prognostic indicator and novel therapeutic target in the case of advanced disease.
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20
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Hwang K, Kim H, Kim H, Kim J. Risk of Anaplastic Large-Cell Lymphoma (ALCL) in Cases of Late Seroma Formation After Breast Implant Insertion. EPLASTY 2021; 21:e4. [PMID: 33747338 PMCID: PMC7941142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose: The aim of this study was to determine the odds ratio of anaplastic large-cell lymphoma in late seroma formation. Methods: In a PubMed search, 415 articles were found using the terms "breast implant AND seroma" (n = 232), "breast implant AND effusion" (n = 42), and "anaplastic large cell lymphoma AND breast (n = 141). Sixty-seven abstracts were read, and 27 full articles were reviewed. Results: Three articles reported the incidence of late seroma in breast implants, with a total of 75 seromas out of 48,211 implants (0.16%). One article reported 48 cases of non-Hodgkin lymphoma from 43,537 implants (0.11%). Another article reported that 11 patients had anaplastic large-cell lymphoma among 389 primary lymphoma of the breast (2.83%). Two articles reported 143 seromas out of 236 anaplastic large-cell lymphomas (60.59%). The risk of anaplastic large-cell lymphoma was significantly higher in the patients having late seroma than those without seroma (odds ratio = 998.93; 95% confidence interval, 768.90-1297.78; P < .001). The incidence of anaplastic large-cell lymphoma in seroma was calculated by dividing the number of anaplastic large cell lymphomas with seroma (n = 143) by total seroma (N = 11,843), which resulted in an incidence of 1.21%. The expected incidence of anaplastic large-cell lymphoma in seroma was 1.21%. Conclusion: If late seroma develops after breast implant insertion, ultrasonography-guided aspiration should be performed, with enzyme-linked-immunosorbent serologic assay for CD30.
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Affiliation(s)
- Kun Hwang
- Department of Plastic Surgery, Inha University School of Medicine, Incheon, Korea
| | - Hun Kim
- Department of Plastic Surgery, Inha University School of Medicine, Incheon, Korea
| | - Hyung Mook Kim
- Department of Plastic Surgery, Inha University Hospital, Incheon, Korea
| | - Joo Ho Kim
- Department of Plastic Surgery, Inha University Hospital, Incheon, Korea
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21
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An unusual case of late hematoma after implant-based breast reconstruction mimicking an anaplastic large cell lymphoma: a case report and literature review. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01783-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AbstractLate hematoma associated with breast implants used in esthetic and reconstructive breast surgery represents a rare entity. These hematomas do not have a clear etiology, but triggering events like trauma, anticoagulant use, capsule contracture, or chronic inflammation are reported in literature. We describe an 82-year-old patient who developed a unilateral intra-capsular hematoma 19 years after mastectomy and breast reconstruction with McGhan 445 g implant. Differential diagnosis with anaplastic large cell lymphoma (ALCL) was considered and potential causes of hematoma were evaluated. Constant pressure forces on chest wall were defined as pathophysiological cause. A systematic literature review concerning late hematoma cases was carried out, focusing on late hematoma etiology and various surgical treatments.Level of evidence: Level V, diagnostic study.
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22
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Marcelli S, Aso J. Preliminary outcomes and comparison of polytech POLYtxt Ⓡ and MESMOsensitive Ⓡ breast implants with focus on late seroma: Single-surgeon, retrospective cohort study on 621 consecutive aesthetic breast surgery cases. J Plast Reconstr Aesthet Surg 2021; 74:2217-2226. [PMID: 33582050 DOI: 10.1016/j.bjps.2020.12.092] [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: 05/03/2020] [Revised: 11/29/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Recent history shows incomplete understanding of the long-term interaction between breast implants and biological tissues. Although complications of silicone-textured implants have been previously reported, conclusive data are still controversial due to the lack of reduced bias, long-term, comparative studies. We present our preliminary outcomes of 3 years aesthetic use of POLYTECH silicone POLYtxtⓇ and MESMO SensitiveⓇ implants. METHODS This article is a retrospective analysis of 621 patients who have undergone primary aesthetic breast surgery (breast augmentation (BA) or augmentation mastopexy). The surgeries were performed by a single surgeon using Polytech microtextured silicone implants (POLYtxt and MESMO). Complications, with main focus on late seroma, were assessed and compared based on texturization type. RESULTS From January 2015 to September 2018, 358 patients were treated with POLYtxt and 263 with MESMO-textured implants. Incidence of complications, such as hematoma, infection, early seroma, capsular contraction and malposition/rotation was comparable between the two groups. Incidence of late seroma was, respectively, 6.4% (POLYtxt) and 0% (MESMO) resulting in a statistically significant difference between the two groups. Overall complications and reinterventions were 12.5%-9.2% (POLYtxt) and 4.5%-3.8% (MESMO), respectively, showing a significantly lower occurrence in the MESMO group. CONCLUSIONS This reduced bias study shows an increased risk in overall complications and reoperations with POLYtxt surface implants compared with MESMO. Furthermore, we registered an exceptionally high rate of late seroma when the more "aggressive" POLYtxt texturization was used. Conversely, a significantly low incidence of adverse events was registered with the MESMO surface, which has turned this device in our first choice in daily practice.
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Affiliation(s)
- S Marcelli
- Private Practice, Calle de Núñez de Balboa, 107, 28006, Madrid, Spain.
| | - J Aso
- Private Practice, Calle de Núñez de Balboa, 107, 28006; Madrid Spain. Department of Plastic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
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23
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Calderan L, Panettiere P, Accorsi D, Marchi A, Bernardi P, Benati D, Conti G, Chirumbolo S, Zingaretti N, Parodi PC, Cisterna B, Sbarbati A. Ultrastructural features of the double capsulated connective tissue around silicone prostheses. Microsc Res Tech 2020; 84:1155-1162. [PMID: 33301210 DOI: 10.1002/jemt.23673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/23/2020] [Accepted: 11/28/2020] [Indexed: 12/21/2022]
Abstract
The implantation of breast prostheses for both aesthetic and reconstructive purposes has been growing exponentially in the last 20 years. Safety and prosthesis lifespan are majorly debated issues in relation to the correlated long-term complications. Mainly the periprosthetic capsule that develops around the implant is often the cause of complications and particularly for macrotextured silicone breast implants. Some reports have tried to elucidate the mechanism by which macrotextured silicone implants undergo damage and cause double capsule formation. In this study, we investigated the morphological characteristics of double capsule of macrotextured implants surgically removed from patients. With the use of microscopy techniques, this work analyzed the newly formed tissue observed in the interaction between synthetic and biological surfaces.
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Affiliation(s)
- Laura Calderan
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Pietro Panettiere
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Danilo Accorsi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Alessandra Marchi
- Reconstructive Surgery, Unit of "Ricostruzione Mammaria Post Mastectomia", Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Paolo Bernardi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Donatella Benati
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giamaica Conti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Salvatore Chirumbolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicola Zingaretti
- Clinic of Plastic and Reconstructive Surgery of Udine, University of Udine, Udine, Italy
| | - Pier Camillo Parodi
- Clinic of Plastic and Reconstructive Surgery of Udine, University of Udine, Udine, Italy
| | - Barbara Cisterna
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Sbarbati
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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24
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Drainage on augmentation mammoplasty: Does it work? J Plast Reconstr Aesthet Surg 2020; 74:1093-1100. [PMID: 33250388 DOI: 10.1016/j.bjps.2020.10.059] [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: 05/11/2020] [Revised: 06/18/2020] [Accepted: 10/20/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Breast prostheses could be associated with complications, despite many studies on surgical materials and techniques. The role of surgical drainage in preventing complications on breast prostheses surgery is controversial. OBJECTIVES This study aimed to evaluate the role and effectiveness of vacuum drainage in the augmentation mammoplasty. METHODS A prospective multicentric randomized comparative clinical trial was conducted with 150 patients, who were the candidates for breast augmentation. The candidates were split into two groups to analyze the breast drain role. Group1: closed-suction drainage; measurements were taken every 24 h for 48 h. Group2: control (no drainage); all the patients were submitted to a clinical and postoperative ultrasonography evaluation (7th day and 3rd month). The late consultations (1st-, 2nd-, and 3rd-year postoperative time) were carried out to identify any complication, such as infection, seroma, hematoma, asymmetry, hypertrophic scarring, rippling, implant position, visible edges, and sensibility alteration. RESULTS A total of 150 female patients were operated with 300 breast implants placed into subglandular pocket. In the first 24 h postoperative (D1), the drainage volume ranged from 12 ml to 210 ml (mean= 74.90 ml; SD= 43.29 ml). After 24 h, on the second day (D2), the collected volume ranged from 10 ml to 120 ml (mean= 44.76 ml; SD= 24.80 ml). The total drainage volume in the 48 h ranged from 22 ml to 320 ml (mean= 119.7 ml; SD= 62.20 ml). The breast ultrasonography series (BUSGS) analysis was done on the 7th day and 3rd month in both groups. There was no significant difference between G1 and G2 groups (p = 0.05 and 0.25, respectively). In the follow-up, some patients (33-44%) declared sensitivity disturbing on the nipple-areola complex (NAC) and lower breast segment. CONCLUSIONS The closed-suction breast drainage in breast augmentation was associated with high cost and time-consuming and not demonstrated any benefit in a recent postoperative time.
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25
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Ghosh T, Duncavage E, Mehta-Shah N, McGuire PA, Tenenbaum M, Myckatyn TM. A Cautionary Tale and Update on Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). Aesthet Surg J 2020; 40:1288-1300. [PMID: 31894234 DOI: 10.1093/asj/sjz377] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Breast implant-associated anaplastic large T-cell lymphoma (BIA-ALCL) was first recognized by the World Health Organization in 2016. The total number of cases worldwide continues to increase, with >800 cases confirmed through a combination of Food and Drug Administration data, verified reports, and registries. To date, 33 deaths have been reported. Typical presentation includes a late seroma containing monoclonal T cells that are CD30 positive and anaplastic lymphoma kinase negative. We present a review of the current literature and report on 3 cases of BIA-ALCL at our institution, which serve to illustrate our approach to diagnosis and management of this disease. In 2 cases, the diagnosis of BIA-ALCL was not initially confirmed due to an incomplete workup but was recognized upon explantation. The seroma fluid was sent for flow cytometry. Initially, the cells were reported as morphologically suspicious for malignancy with phenotypically normal T cells based on standard CD3+ T-cell gating. Subsequent cytology specimens were reported as consistent with recurrent adenocarcinoma. However, upon regating of flow-cytometry data, a population of CD30+, CD3- T cells was noted and the diagnosis of BIA-ALCL was confirmed by immunohistochemical stains of the excised breast capsule specimen. Given the increasing incidence of this disease, as plastic surgeons we must stay informed to order the correct workup to avoid misdiagnosis and be prepared to appropriately refer affected patients to centers with multidisciplinary teams experienced in the management of BIA-ALCL. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Trina Ghosh
- Division of Plastic and Reconstructive Surgery, Washington University in St Louis School of Medicine, St Louis, MO
| | - Eric Duncavage
- Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, MO
| | - Neha Mehta-Shah
- Division of Hematology and Oncology, Washington University in St Louis School of Medicine, St Louis, MO
| | | | - Marissa Tenenbaum
- Division of Plastic and Reconstructive Surgery, Washington University in St Louis School of Medicine, St Louis, MO
| | - Terence M Myckatyn
- Division of Plastic and Reconstructive Surgery, Washington University in St Louis School of Medicine, St Louis, MO
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Biological and genetic landscape of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Eur J Surg Oncol 2020; 47:942-951. [PMID: 33158639 DOI: 10.1016/j.ejso.2020.10.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/16/2020] [Accepted: 10/26/2020] [Indexed: 12/30/2022] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon form of non-Hodgkin lymphoma (cancer of the immune system) that can develop around breast implants. Breast implants are among the most commonly used medical devices for cosmetic or reconstructive purposes. In the past few years, the number of women with breast implants diagnosed with anaplastic large cell lymphoma (ALCL) has increased, and several studies have suggested a direct association between breast implants and an increased risk of this disease. Although it has been hypothesized that chronic stimulation of the immune system caused by implant materials and biofilms as well as a possible genetic predisposition play an important role in this disease, the cellular and molecular causes of BIA-ALCL are not fully understood. This review aims to describe the current understanding around the environmental and molecular drivers of BIA-ALCL as well as the genetic and chromosomal abnormalities identified in this disease to date.
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Verde F, Vigliar E, Romeo V, Campanino MR, Accurso A, Canta L, Garbino N, Basso L, Cavaliere C, Nicolai E, Imbriaco M. Breast implant associated anaplastic large cell lymphoma (BIA-ALCL): a challenging cytological diagnosis with hybrid PET/MRI staging and follow-up. Breast Cancer 2020; 28:527-532. [PMID: 33131026 PMCID: PMC7925497 DOI: 10.1007/s12282-020-01178-w] [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: 04/27/2020] [Accepted: 10/13/2020] [Indexed: 11/30/2022]
Abstract
We report a case of a 55-year-old woman with left breast cosmetic augmentation performed 5 years earlier, showing at ultrasound a left small amount of peri-implant effusion suspicious for an anaplastic large cell lymphoma localization. The final diagnosis was obtained by cytology using a small amount of fluid (6 ml). Subsequently, hybrid 18F-FDG PET/MRI was used for pre-operative staging and follow-up. An appropriate management of BIA-ALCL could be obtained even in cases of a small amount of peri-implant effusion, using a comprehensive approach of clinical and imaging evaluation, including PET/MRI as useful and innovative staging imaging technique.
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Affiliation(s)
- Francesco Verde
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - Elena Vigliar
- Department of Public Health, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - Valeria Romeo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy.
| | - Maria Raffaela Campanino
- Department of Public Health, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - Antonello Accurso
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Luigi Canta
- Unit of Plastic and Reconstructive Surgery, AOU Federico II, Via S. Pansini, 5, 80131, Naples, Italy
| | - Nunzia Garbino
- IRCCS SDN, Via Emanuele Gianturco 113, 80143, Naples, Italy
| | - Luca Basso
- IRCCS SDN, Via Emanuele Gianturco 113, 80143, Naples, Italy
| | | | | | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
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Piat JM, Giovinazzo V, Talha A, Dubost V, Maiato AP, Quoc CH. La reconstruction mammaire par le minidorsal lipofillé. KINÉSITHÉRAPIE, LA REVUE 2020; 20:16-20. [DOI: 10.1016/j.kine.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Lymphome anaplasique à grandes cellules associé aux implants mammaires : qu’en savons-nous ? Partie I. IMAGERIE DE LA FEMME 2020. [DOI: 10.1016/j.femme.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Breast Implant-associated Anaplastic Large Cell Lymphoma in Colombia: Report of a Multidisciplinary National Registry. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3013. [PMID: 32983773 PMCID: PMC7489702 DOI: 10.1097/gox.0000000000003013] [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: 01/26/2020] [Accepted: 06/08/2020] [Indexed: 02/06/2023]
Abstract
An estimated 43,390 breast augmentation surgeries (86,780 implants) and 1486 breast implant reconstructions are performed annually in Colombia, representing the second-most breast surgery destination in South America, the fourth in the western hemisphere, and the fifth country worldwide. No previous reports have evaluated the incidence of breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) epidemiology or outcomes in a Hispanic population. Published data on the incidence of this disease in Colombia are unknown; therefore, a National Joint Multidisciplinary Committee was developed between the Colombian scientific societies of Mastology, Plastic Surgery, Hemato-Oncology, and the Invima (The National Food and Drug Surveillance Institute) to track national cases of BIA-ALCL.
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Biopsy Results Are Not Sufficient to Exclude Breast Implant-associated Anaplastic Large Cell Lymphoma: A Case Mistaken for Disseminated Silicosis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3153. [PMID: 33133985 PMCID: PMC7544370 DOI: 10.1097/gox.0000000000003153] [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: 05/19/2020] [Accepted: 08/05/2020] [Indexed: 11/26/2022]
Abstract
We present a case report of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) that was mistaken as disseminated silicosis after multiple percutaneous biopsies. The correct diagnosis of BIA-ALCL was confirmed only after a pathologic examination of the capsulectomy specimens. A review of the literature of percutaneous biopsies of ALCL showed a diagnostic yield of only 63%. Although percutaneous biopsies may be facile to obtain and may be diagnostic, in our case, biopsies were not sufficient to exclude the diagnosis of BIA-ALCL.
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Breast implant-associated anaplastic large cell lymphoma in an Asian patient: The first case report from Thailand. Arch Plast Surg 2020; 47:478-482. [PMID: 32713177 PMCID: PMC7520251 DOI: 10.5999/aps.2020.00108] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/07/2020] [Indexed: 12/17/2022] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has received increasing interest among plastic surgeons as a long-term complication of breast augmentation. Although the prognosis is usually good, mortality is a possible outcome. Most of the cases reported in the past two decades have been from the United States, Europe, and Australia, whereas cases of BIA-ALCL in Asia remain rare. Herein, we describe the first known case of BIA-ALCL in Thailand, in which a 32-year-old woman developed BIA-ALCL 3 years after breast augmentation using textured implants. The patient underwent bilateral removal of the implants and ipsilateral total capsulectomy. This case report-the first of its kind from Thailand-should increase awareness of BIA-ALCL among plastic surgeons in Asia. The true incidence of BIA-ALCL in Asia may be underreported.
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La Forgia D, Catino A, Fausto A, Cutrignelli D, Fanizzi A, Gatta G, Losurdo L, Maiorella A, Moschetta M, Ressa C, Scattone A, Portincasa A. Diagnostic challenges and potential early indicators of breast periprosthetic anaplastic large cell lymphoma: A case report. Medicine (Baltimore) 2020; 99:e21095. [PMID: 32791685 PMCID: PMC7387005 DOI: 10.1097/md.0000000000021095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
RATIONALE Anaplastic large T-cell lymphoma (BI-ALCL) is a rare primitive lymphoma described in women with breast implant prostheses, which has been arousing interest in recent years due to its potentially high social impact. The difficult diagnosis associated with the high and increasing number of prosthetic implants worldwide has led to hypothesize an underestimation of the real impact of the disease among prosthesis-bearing women. The aim of this work is to search for specific radiological signs of disease linked to the chronic inflammatory pathogenetic mechanism. PATIENT CONCERNS This work describes a case of BI-ALCL in an American woman with no personal or family history of cancer, who underwent breast augmentation for esthetic purposes at our Institute. After about 10 years of relative well-being, the patient returned to our Institute with clear evidence of breast asymmetry due to the increase in volume of the right breast which had progressively become larger over a period of 6 months. There was no evidence of palpable axillary lymph nodes or other noteworthy signs. DIAGNOSIS The ultrasound and magnetic resonance (MR) tests indicated the presence of seroma with amorphous material in the exudate which was confirmed by indirect signs, visible in right breast mammography. Due to suspected cold seroma, an ultrasound-guided needle aspiration was performed for the cytological analysis of the effusion which highlighted the presence of a number of large-sized atypical cells with an irregular nucleus with CD30 immunoreactivity, leucocyte common antigen (CD45) compatible with the BI-ALCL diagnosis. INTERVENTIONS In our case, a capsulectomy was performed because the disease was limited inside the capsule and periprosthetic seroma. The final histological examination confirmed the stage. LESSONS The patient is being monitored and shows no signs of recurrence of disease >24 months after surgery. CONCLUSION A diagnosis of BI-ALCL can be reached using new radiological indicators, such as fibrin, which is clearly visible by MR in the form of nonvascularized debris of amorphous material hypointense in all sequences, free flowing or adhered to the external surface of the prosthesis.
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Affiliation(s)
| | | | - Alfonso Fausto
- Dip. di Diagnostica per Immagini, Azienda Ospedaliera Universitaria Senese, Siena
| | | | | | - Gianluca Gatta
- Dip. di Medicina di Precisione, Università degli Studi della Campania Luigi Vanvitelli, Napoli
| | - Liliana Losurdo
- Dip. di Scienze Fisiche, della Terra e dell’Ambiente, Università degli Studi di Siena, Siena
| | | | - Marco Moschetta
- Dip. di Emergenza e Trapianti d’organi, Università degli Studi di Bari “Aldo Moro,” Bari
| | - Cosmo Ressa
- I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Bari
| | - Anna Scattone
- I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Bari
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Public Perceptions on Breast Implant–Associated Anaplastic Large Cell Lymphoma. Plast Reconstr Surg 2020; 146:30-37. [DOI: 10.1097/prs.0000000000006889] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Complicaciones infrecuentes de las prótesis de mama. RADIOLOGIA 2020; 62:266-279. [DOI: 10.1016/j.rx.2020.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/10/2019] [Accepted: 01/31/2020] [Indexed: 12/17/2022]
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Sánchez Rubio N, Lannegrand Menéndez B, Duque Muñoz M, Montes Fernández M, Ciudad Fernández M. Uncommon complications of breast prostheses. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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van Haasterecht L, Zada L, Schmidt RW, de Bakker E, Barbé E, Leslie HA, Vethaak AD, Gibbs S, de Boer JF, Niessen FB, van Zuijlen PPM, Groot ML, Ariese F. Label-free stimulated Raman scattering imaging reveals silicone breast implant material in tissue. JOURNAL OF BIOPHOTONICS 2020; 13:e201960197. [PMID: 32049417 DOI: 10.1002/jbio.201960197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/05/2020] [Accepted: 02/07/2020] [Indexed: 06/10/2023]
Abstract
Millions of women worldwide have silicone breast implants. It has been reported that implant failure occurs in approximately a tenth of patients within 10 years, and the consequences of dissemination of silicone debris are poorly understood. Currently, silicone detection in histopathological slides is based on morphological features as no specific immunohistochemical technique is available. Here, we show the feasibility and sensitivity of stimulated Raman scattering (SRS) imaging to specifically detect silicone material in stained histopathological slides, without additional sample treatment. Histology slides of four periprosthetic capsules from different implant types were obtained after explantation, as well as an enlarged axillary lymph node from a patient with a ruptured implant. SRS images coregistered with bright-field images revealed the distribution and quantity of silicone material in the tissue. Fast and high-resolution imaging of histology slides with molecular specificity using SRS provides an opportunity to investigate the role of silicone debris in the pathophysiology of implant-linked diseases.
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Affiliation(s)
- Ludo van Haasterecht
- LaserLaB Amsterdam, Department of Physics and Astronomy, Faculty of Sciences Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC Location VUMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Liron Zada
- LaserLaB Amsterdam, Department of Physics and Astronomy, Faculty of Sciences Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Environment and Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Robert W Schmidt
- LaserLaB Amsterdam, Department of Physics and Astronomy, Faculty of Sciences Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Erik de Bakker
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC Location VUMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC Location VUMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Ellis Barbé
- Department of Pathology, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - Heather A Leslie
- Department of Environment and Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - A Dick Vethaak
- Department of Environment and Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Deltares, Marine and Coastal Systems, Delft, The Netherlands
| | - Susan Gibbs
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC Location VUMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johannes F de Boer
- LaserLaB Amsterdam, Department of Physics and Astronomy, Faculty of Sciences Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frank B Niessen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC Location VUMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Paul P M van Zuijlen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC Location VUMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Burn Center and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - Marie Louise Groot
- LaserLaB Amsterdam, Department of Physics and Astronomy, Faculty of Sciences Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Freek Ariese
- LaserLaB Amsterdam, Department of Physics and Astronomy, Faculty of Sciences Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Cordeiro PG, Ghione P, Ni A, Hu Q, Ganesan N, Galasso N, Dogan A, Horwitz SM. Risk of breast implant associated anaplastic large cell lymphoma (BIA-ALCL) in a cohort of 3546 women prospectively followed long term after reconstruction with textured breast implants. J Plast Reconstr Aesthet Surg 2020; 73:841-846. [PMID: 32008941 PMCID: PMC7247945 DOI: 10.1016/j.bjps.2019.11.064] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 10/18/2019] [Accepted: 11/24/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The risk of BIA-ALCL for patients with textured breast implants has been estimated between 1/2832 and 1/30,000 women. Existing studies estimating the numbers exposed and at risk, may have under reported cases, and/or lacked comprehensive follow-up. Our objective is to determine the risk of BIA-ALCL in a defined cohort of patients reconstructed with macro-textured breast implants and consistently followed long-term. METHODS A prospective cohort study was conducted in patients who underwent breast reconstruction by a single surgeon at Memorial Sloan Kettering Cancer Center (MSKCC) from December 1992 to December 2017. Major events related to implants were prospectively recorded. We identified cases of BIA-ALCL by cross-checking clinical, pathology and external records data. Patients were followed until lymphoma occurrence or last follow-up. The primary outcomes were incidence rate per person-years and cumulative incidence. RESULTS From 1992 to 2017, 3546 patients underwent 6023 breast reconstructions, mainly after breast cancer removal, or contralateral prophylactic mastectomy, using macro-textured surface expanders and implants. All reconstructions were performed by a single surgeon (PGC). Median follow-up was 8.1 years (range, 3 months - 30.9 years). Ten women, 1/354, developed ALCL after a median exposure of 11.5 years (range, 7.4-15.8 years). Overall risk of BIA-ALCL in our cohort is 1/355 women or 0.311 cases per 1000 person-years (95% CI 0.118 to 0.503). DISCUSSION This study, the first to evaluate the risk of macro-textured breast implants from a prospective database with long term follow-up, demonstrates that the incidence rate of BIA-ALCL may be higher than previously reported. These results can help inform implant choice for women undergoing breast reconstruction.
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Affiliation(s)
- Peter G Cordeiro
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, MRI 1007, New York, NY 10065, United States.
| | - Paola Ghione
- Lymphoma Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States
| | - Andy Ni
- Biostatistics Department, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States
| | - Qunying Hu
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, MRI 1007, New York, NY 10065, United States
| | - Nivetha Ganesan
- Lymphoma Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States
| | - Natasha Galasso
- Lymphoma Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States
| | - Ahmet Dogan
- Hematopathology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States
| | - Steven M Horwitz
- Lymphoma Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States
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Why Do We Need Anatomical Implants? the Science and Rationale for Maintaining Their Availability and Use in Breast Surgery. Aesthetic Plast Surg 2020; 44:253-263. [PMID: 31897627 DOI: 10.1007/s00266-019-01595-z] [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] [Received: 09/30/2019] [Accepted: 12/18/2019] [Indexed: 10/25/2022]
Abstract
The choice between anatomical and round implants is an important decision in breast augmentation surgery; however, both have their place and the decision between them that should be made on a patient-by-patient basis, taking into account the patient's desires, anatomy, and surgical history. In some individuals, there are clear indications for using either anatomical or round devices, and there is good evidence that aesthetic outcomes are better with anatomical implants in some instances. When both types are an option, anatomical devices may offer increased flexibility and, despite a longer learning curve needed to properly manage them, they are associated with positive long-term outcomes and high levels of patient satisfaction. Concerns about implant rotation can be minimized with proper patient selection and surgical technique, and the overall complication rate may favor anatomical over round devices in appropriate patients. Breast implant-associated anaplastic large-cell lymphoma is an important issue, and while rare, it must be considered in the context of the entire patient risk profile. Both anatomical and round implants remain key elements of a complete surgical toolbox in breast augmentation. 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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41
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Breast implant-associated anaplastic large cell lymphoma: A comprehensive review. Cancer Treat Rev 2020; 84:101963. [PMID: 31958739 DOI: 10.1016/j.ctrv.2020.101963] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/28/2019] [Accepted: 01/05/2020] [Indexed: 12/12/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently recognized non-Hodgkin lymphoma of T-cell origin. Despite the low incidence of this new disease, the increasing use of breast implants for cosmetic or post-mastectomy reconstruction purposes places BIA-ALC as an emerging and compelling medical challenge. The real BIA-ALCL pathogenesis has not been fully uncovered so far, while different putative causal factors have been proposed. Breast implants with textured surfaces seem to be associated with nearly all cases of BIA-ALCL, while the real the risk of disease development has not been well estimated so far. Late onset, persistent seroma around breast implant represents the classical clinical presentation. Most of the BIA-ALCL patients presents with localized disease, which confers an excellent prognosis. Unlike other non-Hodgkin lymphomas, surgical excision of the mass has a key role in the treatment. For patients with advanced and disseminated diseases, the treatment did not differ from other types of T-cell lymphoma. For these reasons, BIA-ALCL represents an emerging disease which requires multidisciplinary team approach to well define diagnostic workup and treatment for each patient. This review article aims to summarize available data on BIA-ALCL. First, we will outline available data on BIA-ALCL epidemiology, pathogenesis, diagnostic work-up, and treatment. Second, we will point out the potential psychological implications as well as the risk of perception distortion for women with breast implants, especially for those with previous breast cancer. Lastly, we will summarize the current national recommendations regarding textured breast implants and discuss the diagnostic-therapeutic algorithm for BIA-ALCL management.
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Julien LA, Michel RP, Auger M. Breast implant-associated anaplastic large cell lymphoma and effusions: A review with emphasis on the role of cytopathology. Cancer Cytopathol 2020; 128:440-451. [PMID: 31899606 DOI: 10.1002/cncy.22233] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 12/27/2022]
Abstract
Breast implants are surgically implanted by the hundreds of thousands every year worldwide for reconstructive or aesthetic purposes. Complications related to breast implants include early and late effusions that are often submitted for cytopathological analysis, particularly to exclude the possibility of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a rare disease that generally follows an indolent clinical course, although it is becoming clearer that a subset of patients with adverse features have a poorer prognosis. Since a late-onset breast implant-associated effusion is the most common initial presentation of BIA-ALCL, cytopathological analysis of these effusions is considered the cornerstone and gold standard for rapid, efficient, reliable diagnosis and is critical for appropriate management and treatment. The National Comprehensive Cancer Network recently published clinical guidelines for the diagnosis and management of BIA-ALCL and stresses the essential role of cytopathological analysis, although it remains a matter of debate if all seromas should undergo immunocytochemistry or flow cytometry, particularly for assessment of expression of CD30 irrespective of morphological appearance on cytology. Herein, we review the current knowledge on BIA-ALCL, review the key cytological findings of reactive and malignant effusions related to breast implants, and present a comprehensive cytopathological workup with the presence of atypical cells as the key and pivotal element triggering further ancillary studies. We believe this approach will ensure appropriate and cost-effective management of effusion specimens from breast implants.
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Affiliation(s)
| | - René P Michel
- Department of Pathology, McGill University, Montreal, Canada
| | - Manon Auger
- Department of Pathology, McGill University, Montreal, Canada
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43
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Short-term Safety of Augmentation Mammaplasty Using the BellaGel Implants in Korean Women. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2566. [PMID: 32537308 PMCID: PMC7288882 DOI: 10.1097/gox.0000000000002566] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/16/2019] [Indexed: 01/09/2023]
Abstract
Supplemental Digital Content is available in the text. Asian women are stereotypically characterized by a slim body, smaller breasts and areolae, and larger nipples when compared with White women. They would therefore be vulnerable to displacement of a breast implant if they receive larger implants. They are also prone to hypertrophic and prolonged hyperemic scars. Surgeons should therefore be aware of Asian women’s breast anatomy, healing tendency, and preferences. We conducted this multicenter, retrospective study to assess the short-term safety of the BellaGel implants in Korean women.
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Zingaretti N, Galvano F, Vittorini P, De Francesco F, Almesberger D, Riccio M, Vaienti L, Parodi PC. Smooth Prosthesis: Our Experience and Current State of Art in the Use of Smooth Sub-muscular Silicone Gel Breast Implants. Aesthetic Plast Surg 2019; 43:1454-1466. [PMID: 31342127 DOI: 10.1007/s00266-019-01464-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The objective of this clinical review is to provide an overview of the use of silicone gel-filled breast implants placed in the sub-muscular position, with a focus on complication rates reported for both smooth and textured implants. Furthermore, our experience in this field is also reviewed. METHODS MEDLINE, EMBASE, Web of Science, Scopus, the Cochrane Central and Google Scholar databases were reviewed to identify the literature related to smooth breast implants. Each article was reviewed by two independent reviewers to ensure all relevant publications were identified. The literature search identified 98 applicable articles. Of these, just a few articles were found to have a therapeutic level of evidence. The reference lists in each relevant paper were screened manually to include relevant papers not found through the initial search. RESULTS Eight articles report the risk of capsular contracture when the breast implants were placed in the sub-muscular position. Six of these articles report a similar rate of capsular contracture in smooth and textured implants. Local complications such as wrinkling, late seroma and double capsules were found to be associated with the use of textured breast implants (4 articles). All articles concerning BIA-ALCL reported a total absence occurring in smooth breast implants. All cases have been associated with textured mammary prostheses. CONCLUSION With our expertise in the field and the results of this up-to-date literature review, it can be concluded that there are no significant advantages of using one type of implant surface over the other when placed in the sub-pectoral position. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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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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Tevis SE, Hunt KK, Miranda RN, Lange C, Butler CE, Clemens MW. Differences in Human Leukocyte Antigen Expression Between Breast Implant-Associated Anaplastic Large Cell Lymphoma Patients and the General Population. Aesthet Surg J 2019; 39:1065-1070. [PMID: 30715139 DOI: 10.1093/asj/sjz021] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon T-cell lymphoma associated with textured-surface breast implants. Human leukocyte antigen (HLA) polymorphisms have been described with other forms of lymphoma, but have not been described for BIA-ALCL. OBJECTIVES The aim of this study was to evaluate HLA polymorphisms in BIA-ALCL patients. METHODS We prospectively evaluated HLA alleles in patients with BIA-ALCL. HLA was analyzed by probe-based sequence-specific testing and sequence-based typing. The frequencies of HLA-A, HLA-B, HLA-C, HLA-DRB1, and HLA-DQB1 alleles were evaluated. Allele frequencies in the Caucasian European general population were obtained from the National Marrow Donor Program to serve as normative controls. We estimated the relative risk of BIA-ALCL with 95% confidence intervals from a t test. RESULTS Thirteen patients who had undergone BIA-ALCL and HLA testing were identified from 2017 to 2018. Patients carried 10, 11, and 9 HLA-A, HLA-B, and HLA-C alleles, respectively. There were 8 DRB1 alleles and 5 DQB1 alleles in the BIA-ALCL patients. The A*26 allele occurred significantly more frequently in the general population compared with BIA-ALCL patients (0.2992 vs 0.07692, P < 0.001). CONCLUSIONS Our results identify a difference between HLA A*26 in patients who develop BIA-ALCL and the general population, and may signify genetic susceptibility factors responsible for germline genetic variation in HLA in patients with BIA-ALCL. Further work is needed to elucidate if these alleles are predictive for BIA-ALCL in women with textured-surface breast implants.Level of Evidence: 4.
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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
| | - 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
- Breast Surgery Section Co-editor for Aesthetic Surgery Journal
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Danino MA, Efanov JI, Glicksman CA. Scientific Evidence or Personal Beliefs? Aesthet Surg J 2019; 39:357-358. [PMID: 31038665 DOI: 10.1093/asj/sjz056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Johnny I Efanov
- Resident, Plastic and Reconstructive Surgery Department, University of Montreal Hospital Center, Montreal, QC, Canada
| | - Caroline A Glicksman
- Clinical Assistant Professor of Plastic Surgery, Hackensack Meridian School of Medicine at Seton Hall, Nutley, NJ
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Tradeoffs in Implant Selection for Reconstructive Surgery and Adjuncts Utilized to Maximize Aesthetic Outcomes. Plast Reconstr Surg 2019; 144:51S-59S. [DOI: 10.1097/prs.0000000000005950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gunawardana RT, Dessauvagie BF, Taylor DB. Breast implant-associated anaplastic large cell lymphoma, an under-recognised entity. J Med Imaging Radiat Oncol 2019; 63:630-638. [PMID: 31173460 DOI: 10.1111/1754-9485.12905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/19/2019] [Indexed: 11/30/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare form of T-cell lymphoma, recently linked to the use of certain types of breast implants. Although rare, BIA-ALCL is being increasingly recognised and radiologists can play an important role in its early diagnosis. BIA-ALCL is thought to be related to chronic inflammation from indolent infection of the biofilm surrounding implants leading to malignant transformation of activated T cells in genetically susceptible individuals. Clinical features include breast enlargement or asymmetry, discomfort, heaviness and/or a palpable mass in the context of long-standing implant(s). Ultrasound is the primary imaging modality, and the presence of more than a trace of peri-implant fluid should prompt consideration of aspiration for cytology, flow cytometry and microbiological analysis. This article reviews the clinical, imaging and pathology features of BIA-ALCL. In addition, the current recommended management guidelines for suspected cases are discussed.
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Affiliation(s)
- Ruvini Thashila Gunawardana
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Benjamin F Dessauvagie
- Anatomical Pathology, PathWest Laboratory Medicine W.A., Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Division of Pathology and Laboratory Medicine, Medical School University of Western Australia, Crawley, Western Australia, Australia
| | - Donna B Taylor
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia.,Division of Surgery, Medical School University of Western Australia, Crawley, Western Australia, Australia
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