Breast Implant-Associated Anaplastic Large Cell Lymphoma
Purpose of Review
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently recognised malignancy of T lymphocytes exclusively associated with textured breast implants. This review aims to evaluate existing theories regarding the epidemiology, pathogenesis, clinical evaluation and management of the disease.
The true incidence of BIA-ALCL is difficult to define. Prevailing pathogenic theories recognise the interplay between textured implants, Gram-negative bacteria, host genetics (e.g. JAK/STAT, p53) and time. Patients typically present with a delayed seroma and less commonly with a capsular mass or systemic disease at an average of 8–10 years after implantation. BIA-ALCL staging has evolved from a “liquid tumour” model to a “solid tumour” classification. For localised disease, surgery involving complete capsulectomy and implant removal is the cornerstone of treatment. For more advanced disease, treatment includes surgery followed by chemotherapy (combination anthracycline-based), radiotherapy and the antibody drug conjugate (brentuximab vedotin).
The interplay between the Gram-negative biofilm, implant texturing, genetic mutations and time has been implicated in pathogenesis of BIA-ALCL. The identification of a putative infectious cause is not unique to lymphomagenesis. Future research, investigating BIA-ALCL genetic mutations and immunological modulation with Gram-negative biofilm in BIA-ALCL models is warranted.
KeywordsAnaplastic large cell lymphoma T cell Breast implant Bacteria Biofilm Capsulectomy
Compliance with Ethical Standards
Conflict of Interest
Prof. Deva is a consultant, research coordinator, educator to Allergan, Mentor (Johnson & Johnson), Sientra, Motiva and Acelity (KCI.) He has previously coordinated industry-sponsored research for these companies relating to both biofilms and breast prostheses. Prof. Prince is a consultant and holds research grants with Allergan, Takeda Oncology and Millenium Pharmaceuticals. Dr. P. Rastogi has no affiliations or financial interests to disclose.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
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