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Breast Implant–Associated Anaplastic Large Cell Lymphoma

Proposal for a Monitoring Protocol

Santanelli di Pompeo, Fabio M.D., Ph.D.; Laporta, Rosaria M.D.; Sorotos, Michail M.D.; Di Napoli, Arianna M.D., Ph.D.; Giovagnoli, Maria Rosaria M.D.; Cox, Maria Cristina M.D.; Campanale, Antonella M.D.; Longo, Benedetto M.D., Ph.D.

Plastic and Reconstructive Surgery: August 2015 - Volume 136 - Issue 2 - p 144e–151e
doi: 10.1097/PRS.0000000000001416
Breast: Original Articles
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Background: The authors report four cases of breast implant–associated anaplastic large cell lymphoma (ALCL) from a single institution and propose a multidisciplinary protocol.

Methods: From 2012 to 2014, four breast implant–associated ALCL cases were diagnosed. The authors performed the original operation, and no patients were referred to their practice. Cases 1, 2, and 4 were CD4+/CD30+/ALK ALCL with previous textured-implant reconstruction, whereas case 3 was CD8+/CD30+/ALK ALCL with previous polyurethane-implant augmentation. A retrospective study of all patients who underwent breast implant positioning was performed to identify any misdiagnosed cases.

Results: Of 483 patients, 226 underwent reconstruction with latissimus dorsi flap and prosthesis, 115 had skin-sparing/nipple-sparing mastectomy and prosthesis, 117 underwent an expander/implant procedure, and 25 underwent breast augmentation. Fifty-eight cases (12 percent) underwent implant replacement for capsular contracture, 15 (3.1 percent) experienced late-onset seroma, and four (0.83 percent) had both capsular contracture and seroma. Seventy-seven symptomatic patients (16 percent) underwent surgical revision (capsulectomy/capsulotomy) and/or seroma evacuation. The second look on histologic specimens did not identify misdiagnosed cases. A multidisciplinary protocol for suspected implant-associated ALCL was established. Ultrasound and cytologic examinations are performed in case of periprosthetic effusion. If implant-associated ALCL is diagnosed, implant removal with capsulectomy is performed. If disseminated disease is detected through positron emission tomography/computed tomography of the total body, the patient is referred to the oncology department.

Conclusions: A multidisciplinary protocol is mandatory for both early diagnosis and patient management. Until definitive data emerge regarding the exact etiopathogenesis of breast implant–associated ALCL, the authors suggest offering only autologous reconstruction if patients desire it.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Rome, Italy

From the Plastic Surgery Unit, the Pathology Unit, Department of Clinical and Molecular Medicine, and the Hematology Department, Sant’Andrea Hospital, School of Medicine and Psychology, “Sapienza” University of Rome; and the Plastic Surgery Department, OORR Hospital, University of Foggia, loaned employee at the Italian Ministry of Health, Pharmaceutical Services, and Safety in Health Care.

Received for publication October 19, 2014; accepted February 24, 2015.

Disclosure: The authors report that to the best of their knowledge no financial support or benefits have been received by any author or co-author, and that they have no financial interest in any products, devices, or drugs reported on in the article. Dr. Campanale has collaborated on this study out of work-related activities performed at the Italian Ministry of Health. She has no financial interest to declare in relation to the content of this article.

Fabio Santanelli di Pompeo, M.D., Ph.D., Azienda Ospedaliera Sant’Andrea, U.O.D. Chirurgia Plastica, Via di Grottarossa 1035-1039, 00189 Rome, Italy, fabio.santanelli@uniroma1.it

©2015American Society of Plastic Surgeons