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Anaplastic Large Cell Lymphoma and Breast Implants: A Systematic Review

Kim, Benjamin M.D., M.Phil.; Roth, Carol R.N., M.P.H.; Chung, Kevin C. M.D., M.S.; Young, V. Leroy M.D.; van Busum, Kristin M.P.A.; Schnyer, Christopher M.P.P.; Mattke, Soeren M.D., D.Sc.

Plastic and Reconstructive Surgery: June 2011 - Volume 127 - Issue 6 - p 2141-2150
doi: 10.1097/PRS.0b013e3182172418
Breast: Original Articles
Discussion

Background: In recent years, there have been growing concerns about a possible association of non-Hodgkin's lymphoma—in particular, anaplastic large cell lymphoma (ALCL)—and breast implants. The purpose of this study was to identify and analyze all reported cases of non-Hodgkin's lymphoma occurring in patients with breast implants.

Methods: The authors conducted a systematic literature review of reported cases of non-Hodgkin's lymphoma in patients with breast implants. Publications were identified with a search algorithm, forward searches, and expert nominations. After references were reviewed and assessed for inclusion or exclusion, case-based data were independently abstracted, reconciled, and adjudicated by multiple investigators. The data were then synthesized and analyzed.

Results: Of 884 identified articles, only 83 were relevant to non-Hodgkin's lymphoma involving the breast, and 34 were included in our study. Thirty-six cases of non-Hodgkin's lymphoma in patients with implants were found, of which 29 (81 percent) were ALCLs. Although detailed clinical information was lacking in many cases, ALCL often involved the capsule and/or presented as an unexplained seroma or mass, was negative for anaplastic lymphoma kinase (ALK) expression, and had a relatively indolent clinical course when it developed adjacent to a breast implant.

Conclusions: A form of ALCL, which clinically behaves more like the less aggressive primary cutaneous form of ALK–negative ALCL rather than the more aggressive systemic form, may be associated with breast implants. Future research on the epidemiology and biology of this rare disease is clearly needed to better understand its nature.

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Santa Monica and Los Angeles, Calif.; Boston, Mass.; St. Louis, Mo.; and Ann Arbor, Mich.

From RAND Health and Pardee RAND Graduate School, RAND Corporation; the Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at UCLA; Body Aesthetic Research Center; and the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System.

Received for publication January 4, 2011; accepted February 14, 2011.

The views, opinions, and techniques set forth in this article addressing anaplastic large cell lymphoma in women with breast implants are those of the individual author(s) and do not reflect the views, opinions, or recommendations of the American Society of Plastic Surgeons, the Journal, or the Journal editors. Any treatment recommendations contained in the article are those of the individual author(s) and are not to be considered or construed as practice guidelines, practice standards, or practice parameters. The use of any treatment technique described in the article is at the sole discretion of the physician in the exercise of his or her independent medical judgment taking into account the patient's individual circumstances.

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Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Soeren Mattke, M.D., D.Sc., RAND Corporation, 20 Park Plaza, Suite 720, Boston, Mass. 02116, mattke@rand.org

©2011American Society of Plastic Surgeons