Subject(s)
Breast Implants , Breast Neoplasms , Ichthyosis , Lymphoma, Large-Cell, Anaplastic , Paraneoplastic Syndromes , Humans , Female , Lymphoma, Large-Cell, Anaplastic/etiology , Lymphoma, Large-Cell, Anaplastic/pathology , Breast Implants/adverse effects , Ichthyosis/etiology , Ichthyosis/pathology , Paraneoplastic Syndromes/etiology , Paraneoplastic Syndromes/pathology , Breast Neoplasms/pathology , Middle AgedABSTRACT
BACKGROUND: Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) has been diagnosed in more than 1000 patients in more than 30 countries, although only a few cases have been reported in Latin America and the Caribbean to date. As the second-largest global market for breast implants with a predominance of textured-surface implants, Brazil is a major global market for cosmetic augmentations, making it unlikely that cases of BIA-ALCL are actually scarce. METHODS: A local and voluntary registry of patients with BIA-ALCL was initiated in 2018. All patients diagnosed with BIA-ALCL were confirmed by the World Health Organization criteria. Implant characteristics, disease symptoms, treatment, and oncologic outcomes were assessed. RESULTS: Fourteen cases of BIA-ALCL in a Brazilian population were identified in the Paraná state. Disease-specific diagnostic tests were omitted before surgical intervention in 50 percent of patients. With additional cases from a literature review, the treatment and outcomes of 29 cases of BIA-ALCL in Brazil were assessed. CONCLUSIONS: Compared with other populations, these initial observations suggest that awareness of the disease by the local breast surgery community remains low and that a number of cases may remain undiagnosed. Lack of preoperative diagnostic testing compromises disease treatment, oncologic outcomes, and both short- and long-term surveillance.
Subject(s)
Breast Implantation , Breast Implants , Breast Neoplasms , Lymphoma, Large-Cell, Anaplastic , Humans , Female , Breast Implants/adverse effects , Lymphoma, Large-Cell, Anaplastic/diagnosis , Lymphoma, Large-Cell, Anaplastic/epidemiology , Lymphoma, Large-Cell, Anaplastic/etiology , Brazil/epidemiology , Breast Implantation/adverse effects , Mastectomy , Breast Neoplasms/epidemiology , Breast Neoplasms/etiology , Breast Neoplasms/surgeryABSTRACT
INTRODUCTION: The combination of cytology and multiparametric flow cytometry (MFC) may be useful in the diagnosis of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and may be a practical way to differentiate lymphoma from benign and reactive seromas. Although the Brazilian breast implant market is the second largest in the world, with several manufacturers and the almost exclusive use of textured implants, the occurrence of BIA-ALCL in Brazil is underreported. METHODS: One hundred seventeen sequential collections of suspicious periprosthetic fluid (PF) from 105 Brazilian patients registered between March/2018 and March/2021 were evaluated by routine cytomorphology and flow cytometry. The combination of CD30, HLA-DR, and CD25 was used together with T and B lymphocyte and monocyte evaluation. The PF samples were divided into positive, acute reactive (neutrophilic exudate), or chronic reactive (macrophage or lymphocyte rich), and unavailable samples. RESULTS: Nine BIA-ALCL positive cases (7.7%) were identified, with typical morphology and increased FSC/SSC dispersion, bright expression of CD30, CD25 and HLA-DR, and absence or weakness of T-cell antigens (CD3, CD8, CD4, CD5, and CD7). Reactive samples were acute (n = 18, 15.4%) and chronic (n = 70, 59.8%). Twenty samples were excluded. The mean age of BIA-ALCL patients was 50 years (31-57 years) and 35 years in reactive patients (20-69 years). CONCLUSION: Use of MFC with a comprehensive antibody panel consisting of CD30 in conjunction with CD25 and HLA-DR can discriminate anaplastic cells of BIA-ALCL from lymphoid or neutrophilic reactive cells and should be considered in the initial evaluation of seroma.
Subject(s)
Breast Implants , Breast Neoplasms , Lymphoma, Large-Cell, Anaplastic , Brazil , Breast Neoplasms/diagnosis , Female , Flow Cytometry , Humans , Ki-1 Antigen/metabolism , Lymphoma, Large-Cell, Anaplastic/diagnosis , Lymphoma, Large-Cell, Anaplastic/etiology , Middle Aged , Seroma/pathologySubject(s)
Breast Implants/adverse effects , Lymphoma, Large-Cell, Anaplastic/etiology , Aged , Breast Implantation/adverse effects , Breast Implantation/methods , Breast Implantation/statistics & numerical data , Breast Implants/statistics & numerical data , Cohort Studies , Female , Humans , Lymphoma, Large-Cell, Anaplastic/epidemiology , Middle Aged , Prospective StudiesABSTRACT
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare type of non-Hodgkin T-cell lymphoma, recently defined in the 2016 World Health Organization (WHO) classification of lymphoid neoplasms. It occurs more commonly when textured implants are used and appears clinically as a late seroma. Cytologically, these lesions are composed of large atypical cells with pleomorphic nucleus and an immunophenotype positive for T cell markers and CD30, and negative for ALK1. We report a 56-years-old woman with breast implants who developed a periprosthetic seroma three years after surgery. A fine needle aspiration of the lesion was carried out. Cytology and the immunocytochemical study revealed cells compatible with BIA-ALCL. The flow cytometric study was negative. Excisional biopsy of the capsule was performed, observing that the neoplastic cells were confined to the inner surface of the capsule. Imaging studies did not find evidence of disseminated disease. The present case demonstrates the importance of the study of any late periprosthetic effusion, which can be performed using fine needle aspiration.
Subject(s)
Female , Humans , Middle Aged , Breast Neoplasms , Lymphoma, Large-Cell, Anaplastic , Breast Implants , Breast Implantation , Breast Neoplasms/surgery , Lymphoma, Large-Cell, Anaplastic/surgery , Lymphoma, Large-Cell, Anaplastic/diagnosis , Lymphoma, Large-Cell, Anaplastic/etiology , Breast Implants/adverse effects , Breast Implantation/adverse effects , Biopsy, Fine-Needle , Seroma/etiologySubject(s)
Breast Implants , Breast Neoplasms , Lymphoma, Large-Cell, Anaplastic , Breast Implants/adverse effects , Breast Neoplasms/diagnostic imaging , Female , Humans , Lymphoma, Large-Cell, Anaplastic/diagnostic imaging , Lymphoma, Large-Cell, Anaplastic/etiology , Magnetic Resonance Imaging , Seroma/diagnostic imaging , Seroma/etiologyABSTRACT
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon T-cell, CD-30+/ALK lymphoma. Late (9 years) periprosthetic fluid (seroma) is the most common presentation (90% of the cases). A combination of textured breast implant, bacterial contamination, and genetic predisposition seems to be necessary for BIA-ALCL to occur. There are 35 million patients with implants in the world, and at the present moment, 573 cases of BIA-ALCL have been reported. The risk of developing BIA-ALCL in Australia varies from 1:2832 to 1:86,029, with texture grades 3 and 4 seeming to pose a higher risk than grades 2 and 1. NCCN has established guidelines for diagnosis and treatment, and early diagnosis is the key to cure. At an early stage and for the vast majority of patients, the treatment consists of capsulectomy and implant removal. However, at stages II to IV, a systemic treatment is warranted, including chemotherapy, radiotherapy (residual disease), and brentuximab vedotin. The majority of patients can be cured, and complete capsular removal is the most important factor. So far, 33 patients have died from BIA-ALCL worldwide, with deaths related to delay in diagnosis and treatment. Textured implants have been in the midst of the current implant crisis, and Biocell was recalled worldwide after the latest FDA update on the disease. At the present moment, no medical society or regulatory agency has recommended implant removal. It is about time that we start robust breast implant registries to determine risks. Besides, based on scientific criteria, we must consider all the benefits and risks associated with the available breast devices.Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Subject(s)
Breast Implantation , Breast Implants , Breast Neoplasms , Lymphoma, Large-Cell, Anaplastic , Australia , Breast Implantation/adverse effects , Breast Implants/adverse effects , Breast Neoplasms/surgery , Breast Neoplasms/therapy , Humans , Lymphoma, Large-Cell, Anaplastic/diagnosis , Lymphoma, Large-Cell, Anaplastic/epidemiology , Lymphoma, Large-Cell, Anaplastic/etiologyABSTRACT
BACKGROUND: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an emergent disease that threatens patients with texturized breast implants. Major concerns about the safety of these implants are leading to global changes to restrict the utilization of this product. The principal alternative is to perform breast augmentation utilizing smooth implants, given the lack of association with BIA-ALCL. The implications and costs of this intervention are unknown. OBJECTIVES: The authors of this study determined the cost-effectiveness of smooth implants compared with texturized implants for breast augmentation surgery. METHODS: A tree decision model was utilized to analyze the cost-effectiveness. Model input parameters were derived from published sources. The capsular contracture (CC) rate was calculated from a meta-analysis. Effectiveness measures were life years, avoided BIA-ALCL, avoided deaths, and avoided reoperations. A sensitivity analysis was performed to test the robustness of the model. RESULTS: For avoided BIA-ALCL, the incremental cost was $18,562,003 for smooth implants over texturized implants. The incremental cost-effectiveness ratio was negative for life years, and avoided death and avoided reoperations were negative. The sensitivity analysis revealed that to avoid 1 case of BIA-ALCL, the utilization of smooth implants would be cost-effective for a risk of developing BIA-ALCL equal to or greater than 1:196, and there is a probability of CC with smooth implants equal to or less than 0.096. CONCLUSIONS: The utilization of smooth implants to prevent BIA-ALCL is not cost-effective. Banning texturized implants to prevent BIA-ALCL may involve additional consequences, which should be considered in light of higher CC rates and more reoperations associated with smooth implants than with texturized implants.
Subject(s)
Breast Implantation , Breast Implants , Breast Neoplasms , Lymphoma, Large-Cell, Anaplastic , Breast Implantation/adverse effects , Breast Implants/adverse effects , Breast Neoplasms/etiology , Breast Neoplasms/prevention & control , Breast Neoplasms/surgery , Cost-Benefit Analysis , Humans , Lymphoma, Large-Cell, Anaplastic/etiology , Lymphoma, Large-Cell, Anaplastic/prevention & control , MastectomyABSTRACT
INTRODUCTION: Medical devices such as hip, knee, breast, vascular prostheses, among others, are very useful in different pathologies. We cannot doubt that their use is a great tool, besides being an advance in medicine; they provide a change in the quality of life of many patients; however, they are not exempt from adverse reactions and events. METHODS: We conduct a systematic review about lymphoma in the presences of prostheses other than breast implants. RESULTS: We selected 21 publications with a total of 24 patients. The largest number of prostheses was related to long bones in a total of 13 prostheses. The most frequent symptoms were: pain (52%), inflammation (24%), visible or palpable mass 20%. The most frequent type of lymphoma was non-Hodgkin B cell lymphoma in 14 cases. DISCUSSION: The presence of microparticles make biological degradation and wear of the implants, with macrophage and lymphocyte activation and the consequent production of proinflammatory cytokines such as tumor necrosis factor α, interleukin-1ß, interleukin-6, and prostaglandin 2 (PGE2). CONCLUSION: Lymphoma is not a common disease in patients with prostheses, and more data are needed to identify risk factors and make proper diagnoses. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Subject(s)
Breast Implantation , Breast Implants , Lymphoma, Large-Cell, Anaplastic , Lymphoma , Breast Implantation/adverse effects , Breast Implants/adverse effects , Humans , Lymphoma, Large-Cell, Anaplastic/etiology , Quality of LifeABSTRACT
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare type of non-Hodgkin T-cell lymphoma, recently defined in the 2016 World Health Organization (WHO) classification of lymphoid neoplasms. It occurs more commonly when textured implants are used and appears clinically as a late seroma. Cytologically, these lesions are composed of large atypical cells with pleomorphic nucleus and an immunophenotype positive for T cell markers and CD30, and negative for ALK1. We report a 56-years-old woman with breast implants who developed a periprosthetic seroma three years after surgery. A fine needle aspiration of the lesion was carried out. Cytology and the immunocytochemical study revealed cells compatible with BIA-ALCL. The flow cytometric study was negative. Excisional biopsy of the capsule was performed, observing that the neoplastic cells were confined to the inner surface of the capsule. Imaging studies did not find evidence of disseminated disease. The present case demonstrates the importance of the study of any late periprosthetic effusion, which can be performed using fine needle aspiration.
Subject(s)
Breast Implantation , Breast Implants , Breast Neoplasms , Lymphoma, Large-Cell, Anaplastic , Biopsy, Fine-Needle , Breast Implantation/adverse effects , Breast Implants/adverse effects , Breast Neoplasms/surgery , Female , Humans , Lymphoma, Large-Cell, Anaplastic/diagnosis , Lymphoma, Large-Cell, Anaplastic/etiology , Lymphoma, Large-Cell, Anaplastic/surgery , Middle Aged , Seroma/etiologyABSTRACT
Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare, breast implant-associated T-cell lymphoma in which CD30 is expressed and anaplastic lymphoma kinase (ALK) expression is absent. However, despite the low risk of developing the disease, more information on BIA-ALCL is necessary, because the number of women with breast implants has been increasing worldwide; Brazil is one of the main markets for this type of implant. The objectives of this review are to clarify the issue of BIA-ALCL occurrence after risk-reducing mastectomy, to show the importance of this disease, and to raise awareness among the medical community about this rare pathologic condition. In 2016, BIA-ALCL was included by WHO in the new classification of lymphomas, and this demonstrates the attention that medical entities should give to this disease. Thus, awareness about BIA-ALCL must be broadened among the medical societies and regulatory authorities, both to foster better approaches to this disease, which should be evaluated in a multidisciplinary manner, and to provide better knowledge among health care professionals and the target population about the use of implants.
Subject(s)
Breast Implants/adverse effects , Lymphoma, Large-Cell, Anaplastic/etiology , Female , Humans , Lymphoma, Large-Cell, Anaplastic/pathologyABSTRACT
Although breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare disease, its incidence has been increasing. The aim of this study was to assess the risk of BIA-ALCL in women with breast implants. A systematic search was carried out in Pubmed, Scopus, ScienceDirect, LIVIVO, Cochrane Library, Google Scholar, and OpenGrey databases. The risk assessment of bias was based on the Newcastle-Ottawa Scale. The rarity of BIA-ALCL was a major limitation. Although we have found evidence of an increased risk of BIA-ALCL, further studies are needed to understand why some large samples did not present any case of the disease.
Subject(s)
Breast Implantation/adverse effects , Breast Implants/adverse effects , Lymphoma, Large-Cell, Anaplastic/etiology , Breast Neoplasms/surgery , Case-Control Studies , Cohort Studies , Female , Humans , Incidence , Risk AssessmentABSTRACT
INTRODUCTION: Breast implant selection is multifactorial and must assess risk profiles of the implants. Textured implants are available in an anatomically shaped form and are thought to have lower rates of capsular contracture. However, evidence is mounting that they carry a significantly higher risk of breast implant associated anaplastic large cell lymphoma. Given this relationship, we aimed to assess breast implant preferences and device selection for members of the American Society of Plastic Surgeons (ASPS). METHODS: An online survey of all active members of ASPS was performed. Questions analyzed the surgeons' demographic data as well as implant and tissue expander choices for patients receiving either breast augmentation or reconstruction. Logistic regression models of summarized data were used to assess surgeons' implant choices. RESULTS: The survey was sent to 5000 members and was completed by 824 for a response rate of 16.5%. Demographic data indicate a homogenous sampling of ASPS members from all geographical areas. A majority of surgeons reported that they perform 21-50 implant cases in the last year (n = 219, 28.5%), followed closely by surgeons performing greater than 100 cases (n = 194, 25.3%) and those placing between 51 and 100 (n = 189, 24.6%). Almost one-half of respondents (n = 361, 46.9%) stated that the majority (>50%) of the implants they placed were for cosmetic purposes. Conversely, 306 (37.9%) respondents stated that the majority of implants they placed were for reconstructive purposes and 102 (13.3%) respondents indicated equal placement of cosmetic and reconstructive implants. There were 40.9% (n = 318) surgeons who continue to use textured implants, whereas 59.1% (n = 460) report using only smooth implants. This data includes 47.7% (n = 363) of respondents who report switching to only smooth implants due to awareness of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). CONCLUSIONS: The incidence of BIA-ALCL continues to rise. All known cases have some link to textured implants. With equally efficacious alternatives available with smooth implants, surgeons and patients are altering their implant choices.
Subject(s)
Breast Implants/adverse effects , Breast Neoplasms/etiology , Choice Behavior , Clinical Decision-Making , Lymphoma, Large-Cell, Anaplastic/etiology , Mammaplasty , Prosthesis Design/adverse effects , Surgery, Plastic , Adult , Aged , Female , Health Care Surveys , Humans , Middle Aged , Societies, Medical , Surface Properties , United StatesABSTRACT
BACKGROUND: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon T-cell lymphoma associated with textured-surface breast implants. Human leukocyte antigen (HLA) polymorphisms have been described with other forms of lymphoma, but have not been described for BIA-ALCL. OBJECTIVES: The aim of this study was to evaluate HLA polymorphisms in BIA-ALCL patients. METHODS: We prospectively evaluated HLA alleles in patients with BIA-ALCL. HLA was analyzed by probe-based sequence-specific testing and sequence-based typing. The frequencies of HLA-A, HLA-B, HLA-C, HLA-DRB1, and HLA-DQB1 alleles were evaluated. Allele frequencies in the Caucasian European general population were obtained from the National Marrow Donor Program to serve as normative controls. We estimated the relative risk of BIA-ALCL with 95% confidence intervals from a t test. RESULTS: Thirteen patients who had undergone BIA-ALCL and HLA testing were identified from 2017 to 2018. Patients carried 10, 11, and 9 HLA-A, HLA-B, and HLA-C alleles, respectively. There were 8 DRB1 alleles and 5 DQB1 alleles in the BIA-ALCL patients. The A*26 allele occurred significantly more frequently in the general population compared with BIA-ALCL patients (0.2992 vs 0.07692, P < 0.001). CONCLUSIONS: Our results identify a difference between HLA A*26 in patients who develop BIA-ALCL and the general population, and may signify genetic susceptibility factors responsible for germline genetic variation in HLA in patients with BIA-ALCL. Further work is needed to elucidate if these alleles are predictive for BIA-ALCL in women with textured-surface breast implants.Level of Evidence: 4.
Subject(s)
Breast Implantation/adverse effects , Breast Implants/adverse effects , HLA Antigens/genetics , Lymphoma, Large-Cell, Anaplastic/genetics , Adult , Aged , Alleles , Bone Marrow/pathology , Breast/pathology , Breast/surgery , Breast Implantation/instrumentation , Breast Neoplasms/surgery , Case-Control Studies , Female , Gene Frequency , Genetic Predisposition to Disease , Genotyping Techniques , Humans , Lymphoma, Large-Cell, Anaplastic/diagnosis , Lymphoma, Large-Cell, Anaplastic/etiology , Lymphoma, Large-Cell, Anaplastic/pathology , Mastectomy/adverse effects , Middle Aged , Prospective Studies , Surface PropertiesABSTRACT
Currently, attention has been given to complications related to breast implants, especially due to the presence of anaplastic large cell lymphoma (ALCL) related to silicone implants. Many manuscripts attempt to associate silicone presence with clinical complaints reported by patients, while others try to demonstrate the mechanisms of silicone bleeding by permeability loss of breast implant surfaces. There also are reports of foreign body type reactions from implant fibrous capsule to silicone corpuscles. However, there seems to be no study that correlates the clinical, radiological, and histological correlations of these lesions. The objective of this review is to correlate radiological findings of silicone-induced granuloma of breast implant capsule (SIGBIC) from breast MRI (BMRI) scans and complementary findings of ultrasound (US) and positron emission tomography (PET) scan, and its histology originated from surgical breast implant capsulectomy. To make this correlation possible, we divided SIGBIC into three radiological findings: (1) intracapsular SIGBIC, (2) SIGBIC with extracapsular extension, and (3) mixed SIGBIC associated with seroma. Our experience demonstrates histological-radiological correlation in SIGBIC diagnosis. Knowledge of these findings may demonstrate its real importance in terms of public health and patient management. We believe that SIGBIC is currently underdiagnosed by lack of training, guidance, and management in our clinical practice.
Subject(s)
Breast Implantation , Breast Implants/adverse effects , Breast Neoplasms/surgery , Granuloma/diagnostic imaging , Postoperative Complications/diagnostic imaging , Silicones , Female , Granuloma/etiology , Granuloma/pathology , Humans , Lymphoma, Large-Cell, Anaplastic/etiology , Magnetic Resonance Imaging , Positron-Emission Tomography , Postoperative Complications/pathology , UltrasonographyABSTRACT
El linfoma anaplásico de células grandes asociado a implantes mamarios (BIA-ALCL, breast implant associated-anaplastic large cell lymphoma) es una enfermedad infrecuente, pero el número de casos ha aumentado en los últimos años. Se puede presentar en la consulta del cirujano como un aumento del volumen mamario por derrame periprotésico o como masa capsular. El tratamiento de elección es la cirugía, con explante de las prótesis y exéresis de la cápsula periprotésica. El pronóstico, si el diagnóstico es precoz y el tratamiento es adecuado, es bueno. El objetivo del presente trabajo fue revisar la literatura científica existente hasta la fecha sobre el BIA-ALCL y poner de manifiesto la importancia que este tipo de neoplasia tiene para el cirujano.Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is an infrequent disease, although the number of cases has increased in the recent years. BIA-ALCL is revealed during medical screening as an increase in the mammary volume due to periprosthetic effusion or as a capsular mass. Preferred treatment for BIA-ALCL is surgery, with explantation of the prostheses and exeresis of the periprosthetic capsule. Prognosis, after early diagnosis and adequate treatment, is good. The objective of the present work was to review the existing scientific literature on BIA-ALCL and to show the importance of this type of neoplasia for a successful treatment.
Subject(s)
Breast Implants/adverse effects , Lymphoma, Large-Cell, Anaplastic/etiology , Device Removal , Disease Susceptibility , Female , Global Health , Humans , Incidence , Informed Consent , Lymphoma, Large-Cell, Anaplastic/epidemiology , Lymphoma, Large-Cell, Anaplastic/surgery , Mammaplasty/instrumentation , Morbidity/trends , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/surgery , PrognosisABSTRACT
INTRODUCTION: Anaplastic large cell lymphoma associated with breast implants is receiving increased attention. Most cases have been reported in Europe, North America (USA and Canada), Australia and New Zealand. Fewer cases have been reported in Latin America (including Mexico), Africa and Asia. METHODS: This report was delivered during our national plastic surgery meeting in Cancun in May 2017. Before the meeting, two participants reviewed the literature. The review was performed using the following information sources: PubMed, Embase, Cochrane, Fisterra, Google Scholar and LILACS, with entries from 1980 to August 2015 in several languages (English, Spanish, French and Portuguese). The results were revealed during the meeting to the other participants. The consensus was divided into two parts. The first part included an open-ended question regarding the incidence and prevalence of the problem. The second part included clinical scenarios with different items that were rated by the participants. After this activity, accordance among the responses was evaluated. RESULTS: Seven cases were reported during the meeting (3 from Mexico, 3 from Chile and 1 from Argentina). Fifty percent of the participants reported consulting with guidelines and clinical centers to help with potential cases. Most agreed that further studies must be done in cases of chronic seroma where the capsule plays an important role. DISCUSSION: A current debate exists about the incidence of this problem in Latin America because we did not report the same number of cases as Europe, Australia or North America. More studies are required to determine the differences among reports in Latin America. CONCLUSION: Most representatives agreed that further studies must be done. Concern is increasing, and the problem is known. Other factors involved may be considered, and the problem must not be ignored. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Subject(s)
Breast Implantation/adverse effects , Breast Implants/adverse effects , Breast Neoplasms/etiology , Lymphoma, Large-Cell, Anaplastic/etiology , Practice Guidelines as Topic , Adult , Breast Implantation/methods , Breast Neoplasms/epidemiology , Breast Neoplasms/pathology , Consensus , Female , Humans , Incidence , Latin America/epidemiology , Lymphoma, Large-Cell, Anaplastic/epidemiology , Lymphoma, Large-Cell, Anaplastic/pathology , Middle Aged , Risk AssessmentABSTRACT
BACKGROUND: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare malignancy, recently recognized as a provisional entity by the World Health Organization. Although increasing data have been published on this entity in recent years, a great number of patients and health professionals remain unaware of this diagnosis. CASE PRESENTATION: We herein report the case of a 56-year-old female with Li-FRAUMENI syndrome who presented with late right-sided recurrent breast swelling after prophylactic adenomastectomy with implant reconstruction. Imaging scans revealed an heterogeneous mass adjacent to the implant fibrous capsule. A biopsy of the lesion rendered the diagnosis of a BIA-ALCL. CONCLUSIONS: This case presents similarities with previous reports, but also some particularities, which should be stressed in order to make the diagnosis the earliest possible. The most distinct feature is that this is the second report of BIA-ALCL arising in the setting of Li-FRAUMENI syndrome.
Subject(s)
Breast Implants/adverse effects , Breast Neoplasms/etiology , Li-Fraumeni Syndrome/complications , Lymphoma, Large-Cell, Anaplastic/etiology , Breast Neoplasms/surgery , Female , Humans , Mastectomy , Middle Aged , Paget's Disease, Mammary/etiology , Paget's Disease, Mammary/surgeryABSTRACT
The use of breast implants for aesthetic and reconstructive purposes has become one of the most common procedures performed by plastic surgeons. Several breast implants models exist. They differ in their size, filling, shape and characteristic of the shell, which can be smooth or textured. Capsular contracture is one of the main complications of breast implants. It has been suggested that the use of textured implants could reduce the incidence of capsular contracture. To answer this question, we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We identified 15 studies overall, of which 13 were randomized trials relevant for the question of interest. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. We concluded the use of textured breast implants probably decreases the risk of capsular contracture, however, they might be associated to an increased risk of anaplastic large cell lymphoma.
El uso de implantes mamarios con propósitos estéticos y reconstructivos se ha convertido en uno de los procedimientos más comunes realizados por los cirujanos plásticos. Existen diversos modelos de implantes mamarios, los cuales difieren en su tamaño, relleno, forma y característica de la envoltura, pudiendo ser lisa o texturizada. La contractura capsular es una de las principales complicaciones del uso de implantes mamarios y se ha planteado que las prótesis texturizadas podrían disminuir la incidencia de contractura capsular. Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud a nivel mundial, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Identificamos cinco revisiones sistemáticas que en conjunto incluyen 15 estudios primarios, 13 de ellos correspondientes a ensayos aleatorizados pertinentes a la pregunta de interés. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos tablas de resumen de los resultados utilizando el método GRADE. Concluimos que el uso de prótesis mamaria texturizada probablemente disminuye el riesgo de contractura capsular, sin embargo, podría asociarse a un aumento en el riesgo de linfoma anaplásico de células grandes.