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Breast Implant–Associated Anaplastic Large Cell Lymphoma in Australia and New Zealand: High-Surface-Area Textured Implants Are Associated with Increased Risk

Loch-Wilkinson, Anna M.B.B.S.; Beath, Kenneth J.; Knight, Robert John William M.B.B.S.; Wessels, William Louis Fick M.B.B.S.; Magnusson, Mark M.B.B.S.; Papadopoulos, Tim M.B.B.S.; Connell, Tony B.Sc., M.B.B.S.; Lofts, Julian M.B.B.S.; Locke, Michelle M.B.B.S., M.D.; Hopper, Ingrid M.B.B.S., B.Med.Sci.(Hons.), Ph.D.; Cooter, Rodney M.B.B.S., M.D.; Vickery, Karen B.V.Sc., Ph.D.; Joshi, Preeti Avinash M.B.B.S., D.C.H., Ph.D.; Prince, H. Miles M.B.B.S.(Hons.), M.D., A.F.R.A.C.M.A., M.A.C.D.; Deva, Anand K. B.Sc.(Hons.), M.B.B.S., M.S.

Plastic and Reconstructive Surgery: October 2017 - Volume 140 - Issue 4 - p 645–654
doi: 10.1097/PRS.0000000000003654
Breast: Original Articles
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Background: The association between breast implants and breast implant–associated anaplastic large cell lymphoma (ALCL) has been confirmed. Implant-related risk has been difficult to estimate to date due to incomplete datasets.

Methods: All cases in Australia and New Zealand were identified and analyzed. Textured implants reported in this group were subjected to surface area analysis. Sales data from three leading breast implant manufacturers (i.e., Mentor, Allergan, and Silimed) dating back to 1999 were secured to estimate implant-specific risk.

Results: Fifty-five cases of breast implant–associated ALCL were diagnosed in Australia and New Zealand between 2007 and 2016. The mean age of patients was 47.1 years and the mean time of implant exposure was 7.46 years. There were four deaths in the series related to mass and/or metastatic presentation. All patients were exposed to textured implants. Surface area analysis confirmed that higher surface area was associated with 64 of the 75 implants used (85.3 percent). Biocell salt loss textured (Allergan, Inamed, and McGhan) implants accounted for 58.7 percent of the implants used in this series. Comparative analysis showed the risk of developing breast implant–associated ALCL to be 14.11 times higher with Biocell textured implants and 10.84 higher with polyurethane (Silimed) textured implants compared with Siltex textured implants.

Conclusions: This study has calculated implant-specific risk of breast implant–associated ALCL. Higher-surface-area textured implants have been shown to significantly increase the risk of breast implant–associated ALCL in Australia and New Zealand. The authors present a unifying hypothesis to explain these observations.

Sydney, New South Wales; and Melbourne, Victoria, Australia

From the Faculty of Medical and Health Sciences, Macquarie University; the Joint Breast Implant-Associated ALCL Task Force, American Society of Plastic Surgeons/American Society for Aesthetic Plastic Surgery/New Zealand Association of Plastic Surgeons; the Integrated Specialist Healthcare Education and Research Foundation; the Australian Breast Device Registry, Department of Epidemiology and Preventative Medicine, Monash University; and the Peter MacCallum Cancer Center.

Received for publication October 4, 2016; accepted April 3, 2017.

Disclosure:Professor Deva and Associate Professor Vickery are consultants and research coordinators for Mentor (J&J), Allergan, and Acelity. Dr. Magnusson is a consultant to Allergan. Dr. Connell is a consultant to AirXpanders. The other authors have no financial interest to declare.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s website (www.PRSJournal.com).

A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to PRSJournal.com and click on “Plastic Surgery Hot Topics” in the “Digital Media” tab to watch. On the iPad, tap on the Hot Topics icon.

Anand K. Deva, B.Sc.(Hons.), M.B.B.S., M.S., Suite 301, 2 Technology Place, Macquarie Park, New South Wales 2109, Australia, anand.deva@mq.edu.au

©2017American Society of Plastic Surgeons