Breast Implant–Associated Malignancies: Current Recommendations for Workup and Management | Journal CME-Journal CME Article: Breast Implant–Associated Malignancies: Current Recommendations for Workup and Management (Article)

Journal CME Article: Breast Implant–Associated Malignancies: Current Recommendations for Workup and Management (Article)

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Breast implant–associated malignancies are rare but important complications of implants, especially textured devices. This article reviews three major subtypes: breast implant–associated anaplastic large-cell lymphoma (BIA-ALCL), breast implant–associated B-cell lymphoma (BIA-BCL), and breast implant–associated squamous cell carcinoma (BIA-SCC). BIA-ALCL is the most common, while BIA-SCC is the most aggressive.<br /><br />The most common presenting symptom across all subtypes is a late seroma, usually with breast swelling and pain; skin changes, a palpable mass, or ulceration may also occur. BIA lymphomas often appear about 10 years after implantation, whereas BIA-SCC tends to present later, around 20 years after implantation.<br /><br />Evaluation should begin with ultrasound and/or mammography. Any fluid collection should be aspirated, ideally obtaining at least 50 mL for pathology. Masses should be biopsied. Pathology and immunostaining guide diagnosis: BIA-ALCL is typically CD30-positive and ALK-negative, BIA-BCL is CD20-positive, and squamous lesions are p63-positive. Once diagnosed, PET/CT is recommended to stage disease.<br /><br />Treatment is primarily surgical. For disease confined to the capsule, implant removal with en bloc capsulectomy is usually sufficient. Disease extending beyond the capsule requires wider excision. Advanced disease with lymph node involvement or metastasis needs systemic therapy and sometimes radiation. BIA-ALCL is treated with anthracycline-based chemotherapy or brentuximab vedotin; BIA-BCL chemotherapy depends on lymphoma subtype; BIA-SCC may require chemotherapy, immunotherapy, and chest wall resection.<br /><br />Patients should be followed closely for at least 2 years, with exams every 3 to 6 months and PET/CT every 6 months. Immediate reconstruction may be safe for early capsule-confined disease, but delayed reconstruction is preferred for more advanced cases.

Keywords

breast implant-associated malignancies

BIA-ALCL

BIA-BCL

BIA-SCC

textured implants

late seroma

capsulectomy

PET/CT staging

CD30-positive

squamous cell carcinoma