Clinical Implications and Management of Non-ALCL Breast Implant Capsular Pathology

Abstract

The breast implant capsule is a dynamic structure that forms following the implantation of a device. Although normally benign, increased awareness of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) highlights that disease may arise from the capsule. BIA-ALCL presents as a late seroma or mass but explains few of the late seromas found in breast implant patients. To date, many of these seromas lack a clear cause and are often described as "idiopathic." Several benign and malignant breast implant capsular diseases can cause a late seroma or mass, including breast implant-associated squamous cell carcinoma. Similar to early reports of BIA-ALCL, these conditions are rare and largely limited to case reports or series. The purpose of this special topic is to present a narrative review highlighting capsular abnormalities that contribute to the formation of late seroma or mass in an attempt to broaden the differential diagnosis and help plastic surgeons identify the cause. Specifically, we review the presentation and management of BIA-ALCL, synovial metaplasia, capsular epithelialization, late hematoma, double capsule, breast cancer, squamous cell carcinoma, mesenchymal tumor, and B-cell lymphoma. Although rare, plastic surgeons should consider these capsular conditions as causes of late seromas and masses. Usually, these conditions may be diagnosed by following the National Comprehensive Cancer Network screening guidelines for BIA-ALCL. Thorough evaluation and workup of late seromas and masses may lead to improved characterization of these rare breast implant capsular conditions and improve our understanding of their pathophysiology and management.

Invasive squamous cell carcinoma of the breast associated with breast augmentation implant capsule

“…In patients with BIA-SCC, aspirated fluid should be rich in keratin, and cytology should display abnormal squamous cells. 23 Various adjuvant treatments for BIA-SCC, including chemotherapy and radiation, have had mixed results. Previously reported chemotherapy regimens have generally followed those used for primary SCC of the breast.…”

“…8 Nearly all reported cases have occurred in patients who had breast augmentation over 10 years before presenting with unilateral painful breast swelling (Table 1). [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] It has been shown in previous reports that BIA-SCC can occur with either silicone or saline implants, and that it can be an aggressive disease T A B L E 1 Published cases of squamous cell carcinoma of breast associated with breast implants. with poor prognostic implications.…”

Brustimplantat assoziiertes Plattenepithelkarzinom (BIA-SCC) – eine systematische Literaturübersicht

“…Verschiedene maligne Tumoren sind in den letzten Jahren mit Brustimplantaten und der Kapsel um Brustimplantate in Verbindung gebracht worden [8]. Dazu gehören verschiedene Lymphome und mesenchymale Tumoren [18][19][20][21][22][23].…”

“…Neben der klassischen Kapselfibrose sind seltene, maligne Tumorentitäten der Brustimplantat-Kapsel beschrieben. Hierzu gehört neben dem in den letzten Jahren viel diskutierten BIA-ALCL 9 10 das sogenannte Brustimplantat assoziierte Plattenepithelkarzinom (BIA-SCC) 8 . Das BIA-SCC wird als potenziell aggressiver, epithelialer Tumor der Implantat-Kapsel beschrieben, welcher Lymphknoten- sowie Fernmetastasen aufweisen kann und vom primären SCC der Brust in Patient*innen mit und ohne Implantate unterschieden wird 11 12 .…”

“…B. der Beschaffenheit des Implantats (glatt vs. texturiert), postoperativer Hämatombildung, Biofilm/ Infektion, Trauma, Silikonleckage, und/oder Bestrahlung [6]. So kann eine Kapselfibrose unterschiedlicher Ausprägung entstehen, [7] in seltenen Fällen kommt es aber auch zur Ausbildung eines (Spät-) Seroms oder einer Tumormasse [8]. Die Kapselfibrose führt je nach Stadium zu Verhärtung, Deformierung, Kontraktur und letztlich Schmerzen der vergrößerten oder rekonstruierten Brust.…”