Breast Implant-Associated Anaplastic Large Cell Lymphoma: A systemic review
Keyword(s)
Gregory A. Lamaris MD PhD; Charles E. Butler MD FACS; Anand K. Deva BSc(Med) MBBS MS FRACS; Roberto N. Miranda MD; Kelly K. Hunt MD FACS; Tony Connell MD; Joan E. Lipa MD MSc; Mark W. Clemens MD FACS; Memben
Description
Author(s): Lamaris, Gregory A. MD, PhD; Butler, Charles E. MD, FACS; Deva, Anand K. BSc(Med), MBBS, MS, FRACS; Miranda, Roberto N. MD; Hunt, Kelly K. MD, FACS; Connell, Tony MD; Lipa, Joan E. MD, MSc; Clemens, Mark W. MD, FACS
Background: Standard of care treatment of breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) involves surgical resection with implant removal and complete capsulectomy. We report a case series of BIA-ALCL reconstruction with proposals for timing and technique selection.
Background: Standard of care treatment of breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) involves surgical resection with implant removal and complete capsulectomy. We report a case series of BIA-ALCL reconstruction with proposals for timing and technique selection.
Methods: We retrospectively reviewed and prospectively enrolled all BIA-ALCL patients at 2 tertiary care centers and 1 private plastic surgery practice from 1998 to 2017. Demographics, treatment, reconstruction, pathology staging, patient satisfaction, and oncologic outcomes were reviewed.
Results: We treated 66 consecutive BIA-ALCL patients and 18 (27%) received reconstruction. Seven patients (39%) received immediate reconstruction, and 11 (61%) received delayed reconstruction. Disease stage at presentation was IA (T1N0M0 disease confined to effusion or a layer on luminal side of capsule with no lymph node involvement and no distant spread) in 56%, IB in 17%, IC (T3N0M0 cell aggregates or sheets infiltrating the capsule, no lymph node involvement and no distant spread) in 6%, IIA (T4N0M0 lymphoma infiltrating beyond the capsule, no lymph node involvement and no distant spread) in 11%, and III in 11%. Types of reconstruction included smooth implants (72%), immediate mastopexy (11%), autologous flaps (11%), and fat grafting (6%). Outcomes included no surgical complications, but 1 patient progressed to widespread bone metastasis (6%); ultimately, all patients achieved complete remission. Ninety-four percent were satisfied/highly satisfied with reconstructions, whereas 6% were highly unsatisfied with immediate smooth implants.
Conclusions: Breast reconstruction following BIA-ALCL management can be performed with acceptable complications if complete surgical ablation is possible. Immediate reconstruction is reserved for disease confined to capsule on preoperative positive emission tomography/computed tomography scan. Genetic predisposition and bilateral cases suggest that BIA-ALCL patients should not receive textured implants. Autologous options are preferable for implant adverse BIA-ALCL patients. Patients with extensive disease at presentation should be considered for 6- to 12-month delayed reconstruction with interval positive emission tomography/computed tomography evaluation.
Plastic and Reconstructive Surgery: March 2019 - Volume 143 - Issue 3S - p 51S-58S
doi: 10.1097/PRS.0000000000005569
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