Breast Implant–associated Anaplastic Large Cell Lymphoma in Colombia: Report of a Multidisciplinary National Registry

Abstract

Background: An estimated 43,390 breast augmentation surgeries (86,780 implants) and 1486 breast implant reconstructions are performed annually in Colombia, representing the second-most breast surgery destination in South America, the fourth in the western hemisphere, and the fifth country worldwide. No previous reports have evaluated the incidence of breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) epidemiology or outcomes in a Hispanic population. Published data on the incidence of this disease in Colombia are unknown; therefore, a National Joint Multidisciplinary Committee was developed between the Colombian scientific societies of Mastology, Plastic Surgery, Hemato-Oncology, and the Invima (The National Food and Drug Surveillance Institute) to track national cases of BIA-ALCL. Materials and Methods: We performed a retrospective review (survey-based study) of historical cases since 2011–2019, and a prospective collection of all patients with a confirmed World Health Organization diagnosis of BIA-ALCL identified in a newly established National Registry of BIA-ALCL. The trial was approved by Institutional Review Board (IRB). Results: Eighteen cases of BIA-ALCL were identified in Colombia between 2011 and 2019. Hundred percent developed as sequelae of textured implants. Six patients (33.3%) presented either a peri-implant capsule mass or axillary lymph node involvement. Seven (38.9%) required adjuvant chemotherapy most commonly with CHOP regimen. Different brands of implants were associated with our cases. One death (5.6%) was attributed to BIA-ALCL, and one (5.6%) case displayed with relapsed with bone marrow involvement requiring a bone marrow transplantation. Six cases (33.3%) were identified with advanced stage (IIB-IV). Disease-free survival of 92.3% was achieved at 30.8-month follow-up. Conclusions: Colombia has one of the highest volumes of breast surgery and use of textured surface breast implants in the world. This study is the initial report of an implant registry in South America. A high proportion of advanced disease may be a consequence of delayed presentation, lack of disease awareness, and timely access to tertiary cancer centers for diagnosis and treatment. Brands other than Allergan and Mentor were found to be associated with BIA-ALCL in our study.

Breast Implanted-Associated Anaplastic Large Cell Lymphoma: A Case of Advanced Disease with Flow Cytometric Findings

“… 10 Although breast implant-associated ALCL has largely been underreported in South America, the first breast implant-associated ALCL registry results in South America were recently published from a multidisciplinary group in Colombia. 11 Notably, our case is the first reported SIMA-brand breast implant-associated ALCL case reported thus far in the literature.…”

Prepectoral and Retropectoral Breast-implant–Associated Anaplastic Large-cell Lymphoma

“…7 These types of implants were preferred in Europe compared with those in the United States, although South American 8 countries, such as Brazil and Colombia, were also among the top countries that eventually used these implants. 9 Hence, it is crucial that plastic and breast surgeons worldwide be aware of the presentation of symptoms for its diagnosis, such as seromas (66%–70%) 10,11 or breast masses (8%). 7…”

“…7 These types of implants were preferred in Europe compared with those in the United States, although South American 8 countries, such as Brazil and Colombia, were also among the top countries that eventually used these implants. 9 Hence, it is crucial that plastic and breast surgeons worldwide be aware of the presentation of symptoms for its diagnosis, such as seromas (66%-70%) 10,11 or breast masses (8%). 7 Although US and mammography are the first tool for diagnosis, magnetic resonance imaging, CT with three-dimensional reconstruction, PET-CT, and diffusionweighted imaging can be very useful to accurately determine the extension of the disease.…”

Breast Implant-associated Anaplastic Large Cell Lymphoma after Breast Reconstruction for Breast Cancer

“…According to a 2018 report by the International Society of Aesthetic Plastic Surgery, augmentation mammoplasty with implants is the most frequent cosmetic surgery performed by plastic surgeons: in Colombia, 43,390 cases are performed, and breast reconstruction with implants is done 1486 times a year. 1 …”

“…According to a 2018 report by the International Society of Aesthetic Plastic Surgery, augmentation mammoplasty with implants is the most frequent cosmetic surgery performed by plastic surgeons: in Colombia, 43,390 cases are performed, and breast reconstruction with implants is done 1486 times a year. 1 The first report of BIA-ALCL appeared in 1995 as a case series of women with cutaneous T-cell lymphoma associated with breast implants. Subsequently, in 1997, Keech and Creech reported the association of lymphoma with textured breast implants in a patient presenting with a 2-cm mass with diffuse involvement of the breast capsule.…”