An Unusual Case of BIA-ALCL Associated with Prolonged/Complicated Biocell-Textured Expander, followed by Smooth Round Breast Implant Exposure, and Concurrent Use of Adalimumab
Abstract:reast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare lymphoma associated with long-term placement of textured breast implants. [1][2][3][4] The first case of BIA-ALCL was reported in 1997 5 and, until recently, this disease process was poorly described. There have been approximately 600 to 700 documented cases worldwide, and because of the rarity of the disease, the National Comprehensive Cancer Network did not release staging guidelines until 2017 6 (most recently updated in 2019). BIA… Show more
“…Although there is an ongoing trend in the surgical community toward smooth devices including both implants and expanders, there is very little research on the development of BIA-ALCL related to TTEs, with a single case being described in the literature to date 12,13 . The patient had textured expanders in place for a total of 14 months with subsequent smooth implant placement and was found to develop BIA-ALCL within 6 years of implant placement 12 .…”
Introduction: Because of concerns related to the correlation of breast implantassociated anaplastic large cell lymphoma (BIA-ALCL) and textured implants, the use of smooth devices in breast reconstruction has been increasing. Currently, there is a paucity of literature evaluating the safety of smooth tissue expanders (STEs), which are now being used more frequently in first-stage breast reconstruction. This study sought to compare the safety and outcomes associated with STEs compared with textured tissue expanders in prosthesis-based breast reconstruction. Methods: A single-institution retrospective review of 394 patients undergoing tissue expander-based breast reconstruction (147 smooth and 247 textured) between 2015 and 2019 was conducted. Patient demographics, comorbidities, treatment characteristics, complications, and surgical outcomes were evaluated. Data analysis was performed using Fisher exact and t tests. Results: No significant difference in demographics or complication rates were identified, including rates of hematoma, seroma, wound dehiscence, delayed wound healing, infection, tissue expander malposition, nipple necrosis, mastectomy flap necrosis, reoperation, readmission, and explantation. Average follow-up was 19 and 22 months for the smooth and textured groups, respectively. No cases of BIA-ALCL were identified in either group. Conclusions: With equivocal safety profiles and no demonstrated risk in BIA-ALCL associated with STEs, this study supports the safety of using STEs compared with textured tissue expanders in prosthesis-based breast reconstruction with the advantage in preventing BIA-ALCL and concludes that there is no role for textured breast expanders.
“…Although there is an ongoing trend in the surgical community toward smooth devices including both implants and expanders, there is very little research on the development of BIA-ALCL related to TTEs, with a single case being described in the literature to date 12,13 . The patient had textured expanders in place for a total of 14 months with subsequent smooth implant placement and was found to develop BIA-ALCL within 6 years of implant placement 12 .…”
Introduction: Because of concerns related to the correlation of breast implantassociated anaplastic large cell lymphoma (BIA-ALCL) and textured implants, the use of smooth devices in breast reconstruction has been increasing. Currently, there is a paucity of literature evaluating the safety of smooth tissue expanders (STEs), which are now being used more frequently in first-stage breast reconstruction. This study sought to compare the safety and outcomes associated with STEs compared with textured tissue expanders in prosthesis-based breast reconstruction. Methods: A single-institution retrospective review of 394 patients undergoing tissue expander-based breast reconstruction (147 smooth and 247 textured) between 2015 and 2019 was conducted. Patient demographics, comorbidities, treatment characteristics, complications, and surgical outcomes were evaluated. Data analysis was performed using Fisher exact and t tests. Results: No significant difference in demographics or complication rates were identified, including rates of hematoma, seroma, wound dehiscence, delayed wound healing, infection, tissue expander malposition, nipple necrosis, mastectomy flap necrosis, reoperation, readmission, and explantation. Average follow-up was 19 and 22 months for the smooth and textured groups, respectively. No cases of BIA-ALCL were identified in either group. Conclusions: With equivocal safety profiles and no demonstrated risk in BIA-ALCL associated with STEs, this study supports the safety of using STEs compared with textured tissue expanders in prosthesis-based breast reconstruction with the advantage in preventing BIA-ALCL and concludes that there is no role for textured breast expanders.
“… 55 The median time to diagnosis is roughly 7–10 years after initial breast implantation. 56 , 57 To date, no cases have been diagnosed in patients with an exclusive history of smooth implants, although there have been cases associated with smooth implants preceded by textured tissue expanders 58 suggesting that BIA-ALCL pathogenesis could be related to a component of the implant texturing process.…”
Section: Breast Implant-associated Lymphomamentioning
confidence: 99%
“… 60 , 63 Furthermore, it is important to remove all of the fibrous capsule as the remaining capsule, and scar tissue has been associated with disease recurrence. 58 Figure 9 Treatment options for primary breast lymphomas of T cell origin. ALCL, ALK+: anaplastic large cell lymphoma, anaplastic lymphoma kinase positive.…”
Section: Breast Implant-associated Lymphomamentioning
“…W e read with interest the article by Akhavan et al reporting on a case of breast implant-associated (BIA) anaplastic large-cell lymphoma (ALCL) that developed around a smooth implant after a textured expander was used during therapy with adalimumab. 1 The authors interestingly discussed the potential association between the use of immunosuppressants [particularly anti-tumor necrosis factor (TNF)-α medications] and the development of rare lymphomas, arguing that active use of anti-TNF-α medication could be a relative contraindication to placement of permanent textured implants.…”
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