Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): A Review and the Caribbean Perspective

Abstract

ABSTRACT Objectives Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a rare CD-30 positive, Anaplastic Lymphoma Kinase Negative Non-Hodgkins lymphoma. The current estimated incidence is one to three cases per million implanted women. However, this is likely to rise with the increasing popularity of breast augmentation. This article contains a brief literature review and describes the Caribbean response to BIAALCL. Methods A literature search was done on the PUBMED Database. Keywords included ‘breast implant-associated anaplastic large cell lymphoma’, ‘brentuximab vedotin’, ‘breast implant’, ‘texturized implants’. The Caribbean Association of Plastic and Reconstructive Surgeons (CAPRS) formulated a regional response to BIA-ALCL during their meeting in August 2019. Results The Food and Drug Administration (FDA) has received 573 unique medical device reports of BIA-ALCL worldwide. The time from implantation to diagnosis, ranges from 7.5 to 10 years and the median age at diagnosis ranges from 47 to 58 years. The pathophysiology of BIA-ALCL is likely multifactorial and involves chronic inflammation in response to textured implants and chronic biofilm, in a genetically susceptible person. Early presentation has a good prognosis with treatment (5-year survival rate of 70-90%). Conclusion Recommendations included development of a regional breast implant registry, which will facilitate study on implant use and its complications. They also concluded that texturized devices should be avoided and utilization of smooth alternatives or autologous reconstruction be performed. Additionally, if requested by asymptomatic women, explant of textured implants and total capsulectomy is not unreasonable. However, these patients must be appropriately counselled.