Breast Reconstruction Following Breast Implant-Associated Anaplastic Large Cell Lymphoma.

Abstract

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.

• Authors: Gregory A Lamaris, Charles E Butler, Anand K Deva, Roberto N Miranda, Kelly K Hunt, Tony Connell, Joan E Lipa, Mark W Clemens
• Journal: Plastic and reconstructive surgery (Plast Reconstr Surg) Vol. 143 Issue 3S A Review of Breast Implant-Associated Anaplastic Large Cell Lymphoma Pg. 51S-58S (03 2019) ISSN: 1529-4242 [Electronic] United States
• PMID: 30817556 (Publication Type: Journal Article, Multicenter Study)

Topics

• Adult
• Aged
• Breast Implantation (adverse effects, methods)
• Breast Implants (adverse effects)
• Breast Neoplasms (etiology, pathology, surgery)
• Cohort Studies
• Device Removal (methods)
• Female
• Humans
• Lymphoma, Large-Cell, Anaplastic (etiology, pathology, surgery)
• Mammaplasty (methods)
• Mastectomy (methods)
• Middle Aged
• Prognosis
• Retrospective Studies
• Risk Assessment
• Tertiary Care Centers
• Treatment Outcome