Anaplastic Large-Cell Lymphoma
Of rising concern is a possible association between certain breast implants (ie, textured vs nontextured implants; silicone vs saline implants) and anaplastic large-cell lymphoma (ALCL).9-13 RAND Health14 sponsored a study conducted by 10 multidisciplinary experts, who agreed on the following points:
(1) A positive association exists between breast implants and ALCL, with the actual number of cases probably underrecognized.
(2) Any recurrent, clinically evident seroma developing longer than six months after breast implantation should be aspirated for cytologic analysis.
(3) Anaplastic lymphoma kinase (ALK)–negative ALCL that develops in the vicinity of breast implants is distinct from systemic ALK-negative ALCL, is clinically indolent disease, and has a favorable prognosis.
(4) Management of ALCL requires removal of the involved implant and capsule (a strategy that is likely to prevent recurrence) and evaluation for the disease at other sites.
(5) Adjuvant radiation or chemotherapy need not be offered to women with capsule-confined disease.13,14
Currently, the FDA has called for further research, concluding, “it is not possible to confirm with statistical certainty that breast implants cause ALCL.”11
Because occurrence of ALCL is rare, the absolute risk for the disease may be extremely low. However, primary care providers who detect a seroma or note increased size in one augmented breast over another six months or longer after an augmentation procedure are advised to refer the patient to a plastic surgeon or other appropriate specialist.11
All cases of confirmed ALCL in women with breast implants should be reported to ALCL@plasticsurgery.org. This is a registry begun by the FDA, in conjunction with the Plastic Surgery Foundation and the American Society of Plastic Surgeons, to gather data about ALCL in women with breast implants.