“Breast implants are safe, but no medical device is without risks.”1 From our local and national societies, from our clinics to lecture halls, from our task forces to research groups to unified registries,2,3 and from social media to scientific journal literature, we in the Plastic and Reconstructive Surgery community have been carefully studying and reporting on one particular risk of breast implants: breast implant–associated anaplastic large cell lymphoma (BIA-ALCL). BIA-ALCL is a “rare and highly treatable type of lymphoma that can develop around breast implants. Data show that BIA-ALCL occurs most frequently in patients who have breast implants with textured surfaces.”1 As of this writing in December 2018, the American Society of Plastic Surgeons (ASPS) has received reports of approximately 656 confirmed or suspected cases of BIA-ALCL worldwide (257 in the United States).1 In our Journal, Plastic and Reconstructive Surgery, we have peer-reviewed and published the latest reports and research on ALCL from all over the world, including Italy,4,5 Australia and New Zealand,6 and the United States7; we have also published many multinational investigations.8 These studies, and many more reports in the scientific literature, now indicate that between 1 in 3,800 women6 and 1 in 30,000 women1,7 with textured implants are at risk for developing BIA-ALCL. Even though both ends of the spectrum of risk for ALCL are very low and no surgery and no medical device are without risk, the plastic surgery community has come together to say that this level of risk from breast implants needs to be better understood. We are doing everything in our collective power to research, report, educate, and advance the public and professional understanding of the risk of BIA-ALCL.
For this reason, we are pleased to present this supplemental issue, titled “A Review of Breast Implant-Associated Anaplastic Large Cell Lymphoma.” The voices in this supplement and those behind the scenes represent a broad spectrum of plastic and reconstructive surgeons; some of the finest and most-dedicated men and women tackling this issue head-on from the United States, Australia, the Netherlands, Peru, and more. The guest editors and authors have collaborated to bring you newly written, up-to-date information on breast implants and ALCL. This supplement reviews the history of and pivotal researchers in reporting ALCL, provides initial findings from the PROFILE (Patient Registry and Outcomes for Breast Implants and Anaplastic Large Cell Lymphoma Etiology and Epidemiology) Registry,3 and provides evidence-based entries and updates on ALCL diagnosis, pathogenesis, risk, treatment, molecular drivers, and implications for breast reconstruction. I am grateful for the global and multigenerational approach to discussing this important and timely subject, and I welcome the diverse authorship group to the pages of this Journal. I hope you will find the BIA-ALCL Supplement informative, eye-opening, and educational; I encourage you all to share the articles with your colleagues, and to utilize the latest reviews on the subject to help you inform your breast augmentation and reconstruction patients of the risks and benefits as part of your consultations.
The techniques presented in this supplement to Plastic and Reconstructive Surgery do not necessarily represent best practices or endorsed techniques of the Guest Editors, Editor-in-Chief, Editorial Board, ASPS, or Wolters Kluwer Health. Publication of these supplements does not constitute product or sponsor endorsement by this Journal or the ASPS. None of the materials contained in this supplement are considered to be practice guidelines or best medicine protocols, but are merely the authors’ collective experience and expertise in the prescribed area. These articles represent state-of-the-art studies, in-depth reviews, and personal operative techniques of the authors and have been rigorously peer-reviewed and revised before acceptance.
I am very appreciative for the dedication, flexibility, passion, and durability of this supplement’s guest editors, Mark W. Clemens, MD, and Anand K. Deva, MD. Their commitment, unique experiences and perspectives, clinical and research insights, and persistence are evident throughout this supplement. The Journal recognizes the diverse authors and volunteer peer-reviewers who worked tirelessly and efficiently to write and review these timely and important additions to our literature. I truly appreciate their expertise, knowledge, and devotion.
This supplement was made possible by unrestricted educational grants from Allergan, Sientra, and Establishment Labs. In addition, the supplement is supported by a sponsorship from Mentor. On behalf of the ASPS Executive Committee, the PRS and PRS Global Open Managing Committee, and the PRS Editorial Board, I offer gratitude for the generosity of these supporters. I am appreciative that these companies have come together to help share this important educational information with readers from across many disciplines and across the globe. The content of the supplement was not dictated or influenced by the sponsors, and all financial declarations/affiliations of the authors have been intentionally and redundantly disclosed and printed in this supplement.
Finally, I am very grateful to our publishing team at Wolters Kluwer Health and to my amazing Editorial Office team, especially Editorial Coordinator Christina Carson and Senior Managing Editor Aaron Weinstein, who worked closely on this supplement. The entire Editorial Office team’s steadfastness, energy, and aptitude continuously make Plastic and Reconstructive Surgery the number-one plastic surgery journal in the world.
It is my hope that through this supplement, we can push BIA-ALCL education, research, and data-sharing forward at an accelerated pace so that all of us—industry, surgeons, researchers, and patients alike—may work to pave the path forward together.
3. The Plastic Surgery Foundation. PROFILE. Patient Registry and Outcomes for breast Implants and anaplastic large cell Lymphoma (ALCL) etiology and Epidemiology. Available at https://www.thepsf.org/research/registries/profile
. Accessed December 17, 2018.
4. Nava MB, Adams WP Jr, Botti G, et al.MBN 2016 Aesthetic Breast Meeting BIA-ALCL Consensus Conference Report. Plast Reconstr Surg. 2018;141:40–48.
5. Campanale A, Boldrini R, Marletta M22 cases of breast implant–associated ALCL: awareness and outcome tracking from the Italian Ministry of Health. Plast Reconstr Surg. 2018;141:11e–19e.
6. Loch-Wilkinson A, Beath KJ, Knight RJW, et al.Breast implant–associated anaplastic large cell lymphoma in Australia and New Zealand: high-surface-area textured implants are associated with increased risk. Plast Reconstr Surg. 2017;140:645–654.
7. Doren EL, Miranda RN, Selber JC, et al.U.S. epidemiology of breast implant–associated anaplastic large cell lymphoma. Plast Reconstr Surg. 2017;139:1042–1050.
8. Srinivasa DR, Miranda RN, Kaura A, et al.Global adverse event reports of breast implant–associated ALCL: an international review of 40 government authority databases. Plast Reconstr Surg. 2017;139:1029–1039.