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Long-Term Implications of Implant-Based Breast Reconstruction: What You Should Know About Breast Implant Illness and Breast Implant-Associated ALCL

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Abstract

Purpose of Review

Many women who have a mastectomy will have implant-based breast reconstruction. Long-term complications from breast implant surgery include breast implant illness (BII) and breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Here, we review recent literature regarding BII and BIA-ALCL.

Recent Findings

BII is uncommon; however, some patients report systemic symptoms attributed to their implants. Patients with BII may benefit from implant removal without replacement. Current literature does not suggest that complete removal of the implant capsule adds any clinical benefit. Women with textured breast implants have increased risk of developing BIA-ALCL. Treatment consists of complete excision of the implant and capsule. Providers should follow updated NCCN guidelines for systemic therapies and surveillance.

Summary

Women considering breast implants should be properly counseled on potential long-term complications from implant reconstruction. Surgeons should be well informed of the signs and symptoms of breast implant-associated cancers and systemic illness.

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© National Comprehensive Cancer Network, Inc. 2023. All rights reserved. Accessed October 27, 2023. To view the most recent and complete version of the guideline, go online to NCCN.org [29]. NCCN makes no warranties of any kind whatsoever regarding their content, use, or application and disclaims any responsibility for their application or use in any way

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References

  1. (2022) Aesthetic plastic surgery national databank statistics 2020–2021. In: Aesthetic Surg J. https://doi.org/10.1093/asj/sjac116. Accessed Apr 2024

  2. Atisha DM, Rushing CN, Samsa GP, Locklear TD, Cox CE, Shelley Hwang E, Zenn MR, Pusic AL, Abernethy AP. A national snapshot of satisfaction with breast cancer procedures. Ann Surg Oncol. 2015;22:361–9. https://doi.org/10.1245/s10434-014-4246-9.

    Article  PubMed  Google Scholar 

  3. Atisha D, Alderman AK, Lowery JC, Kuhn LE, Davis J, Wilkins EG. Prospective analysis of long-term psychosocial outcomes in breast reconstruction: two-year postoperative results from the Michigan breast reconstruction outcomes study. Ann Surg. 2008;247:1019–28. https://doi.org/10.1097/SLA.0b013e3181728a5c.

    Article  PubMed  Google Scholar 

  4. (2020) Breast implants - certain labeling recommendations guidance for industry and food and drug administration staff to improve patient communication. In: U.S. Food and Drug Administration ( FDA). https://www.fda.gov/regulatory-information/search-fda-guidance-documents/breast-implants-certain-labeling-recommendations-improve-patient-communication. Accessed Apr 2024

  5. Bondurant E (1999) Safety of silicone breast implants. In: Institute of Medicine (US) Committee on the safety of silicone breast implants. http://www.nap.edu/catalog/9602. Accessed Apr 2024

  6. Ashar BS. Assessing the risks of breast implants and FDA’s vision for the National Breast Implant Registry. Ann Surg. 2019;269:37–8. https://doi.org/10.1097/SLA.0000000000003052.

    Article  PubMed  Google Scholar 

  7. Balk EM, Earley A, Avendano EA, Raman G. Long-term health outcomes in women with silicone gel breast implants: a systematic review. Ann Intern Med. 2016;164:164. https://doi.org/10.7326/M15-1169.

    Article  PubMed  Google Scholar 

  8. Magnusson MR, Cooter RD, Rakhorst H, McGuire PA, Adams WP, Deva AK. Breast implant illness: a way forward. Plast Reconstr Surg. 2019;143:74S-81S. https://doi.org/10.1097/PRS.0000000000005573.

    Article  CAS  PubMed  Google Scholar 

  9. Adidharma W, Latack KR, Colohan SM, Morrison SD, Cederna PS. Breast implant illness: are social media and the internet worrying patients sick? Plast Reconstr Surg. 2020;145:225e–7e. https://doi.org/10.1097/PRS.0000000000006361.

    Article  CAS  PubMed  Google Scholar 

  10. Atiyeh B, Emsieh S. Breast implant illness (BII): real syndrome or a social media phenomenon? A narrative review of the literature. Aesth Plast Surg. 2022;46:43–57. https://doi.org/10.1007/s00266-021-02428-8.

    Article  Google Scholar 

  11. De Vries CEE, Kaur MN, Klassen AF, Sommers K, Hume KM, Pusic AL. Understanding breast implant–associated illness: a Delphi survey defining most frequently associated symptoms. Plast Reconstr Surg. 2022;149:1056e–61e. https://doi.org/10.1097/PRS.0000000000009088.

    Article  PubMed  Google Scholar 

  12. Cohen Tervaert J, Mohazab N, Redmond D, Van Eeden C, Osman M. Breast implant illness: scientific evidence of its existence. Expert Rev Clin Immunol. 2022;18:15–29. https://doi.org/10.1080/1744666X.2022.2010546.

    Article  CAS  PubMed  Google Scholar 

  13. (2022) Breast implant symptoms. In: Healing breast implant illness. www.healingbreastimplantillness.com/breast-implant-symptoms/. Accessed 10 Apr 2023

  14. Katsnelson JY, Spaniol JR, Buinewicz JC, Ramsey FV, Buinewicz BR. Outcomes of implant removal and capsulectomy for breast implant illness in 248 patients. Plast Recons Surg Global Open. 2021;9: e3813. https://doi.org/10.1097/GOX.0000000000003813.

    Article  Google Scholar 

  15. Bardel A, Wallander M-A, Wedel H, Svärdsudd K. Age-specific symptom prevalence in women 35–64 years old: a population-based study. BMC Public Health. 2009;9:37. https://doi.org/10.1186/1471-2458-9-37.

    Article  PubMed  PubMed Central  Google Scholar 

  16. M Marques, SA Brown, I Oliveira, MNDS Cordeiro, A Morales-Helguera, A Rodrigues, J Amarante, 2010 Long-term follow-up of breast capsule contracture rates in cosmetic and reconstructive cases: plastic and reconstructive surgery 126 769-778 https://doi.org/10.1097/PRS.0b013e3181e5f7bf

  17. McGuire P, Clauw DJ, Hammer J, Haws M, Adams WP. A practical guide to managing patients with systemic symptoms and breast implants. Aesthetic Surg J. 2022;42:397–407. https://doi.org/10.1093/asj/sjab375.

    Article  Google Scholar 

  18. Glicksman C, McGuire P, Kadin M, Lawrence M, Haws M, Newby J, Ferenz S, Sung J, Wixtrom R. Impact of capsulectomy type on post-explantation systemic symptom improvement: findings from the ASERF systemic symptoms in women-biospecimen analysis study: part 1. Aesthetic Surg J. 2022;42:809–19. https://doi.org/10.1093/asj/sjab417.

    Article  Google Scholar 

  19. Keech JA, Creech BJ. Anaplastic T-cell lymphoma in proximity to a saline-filled breast implant. Plast Recons Surg. 1997;100(554):555. https://doi.org/10.1097/00006534-199708000-00065.

    Article  Google Scholar 

  20. Clemens MW, Miranda RN. Coming of age: breast implant-associated anaplastic large cell lymphoma after 18 years of investigation. Clin Plast Surg. 2015;42:605–13. https://doi.org/10.1016/j.cps.2015.06.006.

    Article  PubMed  Google Scholar 

  21. (2023) BIA-ALCL physician resources. In: American Society of Plastic Surgeons. https://www.plasticsurgery.org/for-medical-professionals/health-policy/bia-alcl-physician-resources. Accessed 9 Mar 2023

  22. Doren EL, Miranda RN, Selber JC, Garvey PB, Liu J, Medeiros LJ, Butler CE, Clemens MW. U.S. Epidemiology of breast implant–associated anaplastic large cell lymphoma. Plast Reconstr Surg. 2017;139:1042–50. https://doi.org/10.1097/PRS.0000000000003282.

    Article  CAS  PubMed  Google Scholar 

  23. (2019) FDA takes action to protect patients from risk of certain textured breast implants; requests Allergan voluntarily recall certain breast implants and tissue expanders from market. In: FDA. https://www.fda.gov/news-events/press-announcements/fda-takes-action-protect-patients-risk-certain-textured-breast-implants-requests-allergan. Accessed 17 Aug 2023

  24. McCarthy CM, Roberts J, Mullen E, Loyo-Berrios N, Clemens MW, Yoon SW, Levinson H, Sommers K, Hume K, Carr L. Patient registry and outcomes for breast implants and anaplastic large cell lymphoma etiology and epidemiology (PROFILE): Updated Report 2012–2020. Plast Reconstr Surg. 2023;152:16S-24S. https://doi.org/10.1097/PRS.0000000000010475.

    Article  CAS  PubMed  Google Scholar 

  25. Bizjak M, Selmi C, Praprotnik S, Bruck O, Perricone C, Ehrenfeld M, Shoenfeld Y. Silicone implants and lymphoma: the role of inflammation. J Autoimmun. 2015;65:64–73. https://doi.org/10.1016/j.jaut.2015.08.009.

    Article  CAS  PubMed  Google Scholar 

  26. Jacombs A, Tahir S, Hu H, Deva AK, Almatroudi A, Wessels WLF, Bradshaw DA, Vickery K. In vitro and in vivo investigation of the influence of implant surface on the formation of bacterial biofilm in mammary implants. Plast Reconstr Surg. 2014;133:471e–80e. https://doi.org/10.1097/PRS.0000000000000020.

    Article  CAS  PubMed  Google Scholar 

  27. Brody GS, Deapen D, Taylor CR, Pinter-Brown L, House-Lightner SR, Andersen JS, Carlson G, Lechner MG, Epstein AL. Anaplastic large cell lymphoma occurring in women with breast implants: analysis of 173 cases. Plast Reconstr Surg. 2015;135:695–705. https://doi.org/10.1097/PRS.0000000000001033.

    Article  CAS  PubMed  Google Scholar 

  28. (2023) T-cell lymphomas. In: NCCN clinical practice guidelines in oncology. https://www.nccn.org/professionals/physician_gls/pdf/t-cell.pdf. Accessed 9 Oct 2023

  29. Clemens MW, Jacobsen ED, Horwitz SM. 2019 NCCN consensus guidelines on the diagnosis and treatment of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Aesthetic Surg J. 2019;39:S3–13. https://doi.org/10.1093/asj/sjy331.

    Article  Google Scholar 

  30. Clemens MW, Medeiros LJ, Butler CE, Hunt KK, Fanale MA, Horwitz S, Weisenburger DD, Liu J, Morgan EA, Kanagal-Shamanna R, Parkash V, Ning J, Sohani AR, Ferry JA, Mehta-Shah N, Dogan A, Liu H, Thormann N, Di Napoli A, Lade S, Piccolini J, Reyes R, Williams T, McCarthy CM, Hanson SE, Nastoupil LJ, Gaur R, Oki Y, Young KH, Miranda RN. Complete surgical excision is essential for the management of patients with breast implant–associated anaplastic large-cell lymphoma. JCO. 2016;34:160–8. https://doi.org/10.1200/JCO.2015.63.3412.

    Article  CAS  Google Scholar 

  31. Miranda RN, Aladily TN, Prince HM, Kanagal-Shamanna R, De Jong D, Fayad LE, Amin MB, Haideri N, Bhagat G, Brooks GS, Shifrin DA, O’Malley DP, Cheah CY, Bacchi CE, Gualco G, Li S, Keech JA, Hochberg EP, Carty MJ, Hanson SE, Mustafa E, Sanchez S, Manning JT, Xu-Monette ZY, Miranda AR, Fox P, Bassett RL, Castillo JJ, Beltran BE, De Boer JP, Chakhachiro Z, Ye D, Clark D, Young KH, Medeiros LJ. Breast implant–associated anaplastic large-cell lymphoma: long-term follow-up of 60 patients. JCO. 2014;32:114–20. https://doi.org/10.1200/JCO.2013.52.7911.

    Article  Google Scholar 

  32. (2023) UPDATE: Breast implants: reports of squamous cell carcinoma and various lymphomas in capsule around implants: FDA safetycommunication. In: U.S. Food and Drug Administration (FDA). https://www.fda.gov/medical-devices/safety-communications/update-reports-squamous-cell-carcinoma-scc-capsule-around-breast-implants-fda-safety-communication. Accessed Apr 2024

  33. Fijany AJ, Chaker SC, Hung Y-C, Zago I, Friedlich N, Olsson SE, Montorfano L, Mubang RN, Givechian KB, Boctor MJ, Pekarev M, Martinez-Jorge J, Slater ED (2023) Complication profiles of smooth vs textured tissue expanders in breast reconstruction: a systematic review and meta-analysis. Aesthetic Surg J. sjad319. https://doi.org/10.1093/asj/sjad319

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Authors and Affiliations

  1. Department of Plastic Surgery, Medical College of Wisconsin, 1155 N. Mayfair Rd. Ste. T2600, Wauwatosa, Milwaukee, 53226 WI, USA

    Nelson A. Rodriguez-Unda, Conner J. McMains & Erin L. Doren

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  1. Nelson A. Rodriguez-Unda
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All authors contributed equally to the preparation and writing of this manuscript.

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Correspondence to Erin L. Doren.

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Rodriguez-Unda, N.A., McMains, C.J. & Doren, E.L. Long-Term Implications of Implant-Based Breast Reconstruction: What You Should Know About Breast Implant Illness and Breast Implant-Associated ALCL. Curr Breast Cancer Rep (2024). https://doi.org/10.1007/s12609-024-00545-2

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