The evaluation of the delayed swollen breast in patients with a history of breast implants

Abstract

Breast implants, whether placed for reconstructive or cosmetic purposes, are rarely lifetime devices. Rupture, resulting from compromised implant shell integrity, and capsular contracture caused by constriction of the specialized scar tissue that normally forms around breast implants, have long been recognized, and remain the leading causes of implant failure. It is apparent, however, that women with breast implants may also experience delayed breast swelling due to a range of etiologic factors. While a majority of delayed seromas associated with breast implants have a benign etiology, this presentation cannot be ignored without an adequate workup as malignancies such as breast implant associated anaplastic large cell lymphoma (BIA-ALCL), breast implant associated diffuse large B-cell lymphoma (BIA-DLBCL), and breast implant associated squamous cell carcinoma (BIA-SCC) can have a similar clinical presentation. Since these malignancies occur with sufficient frequency, and with sometimes lethal consequences, their existence must be recognized, and an appropriate diagnostic approach implemented. A multidisciplinary team that involves a plastic surgeon, radiologist, pathologist, and, as required, surgical and medical oncologists can expedite judicious care. Herein we review and further characterize conditions that can lead to delayed swelling around breast implants.

Breast silicone implants’ pericapsular impairment: current underdiagnosed status

“…Based on our observations, we linked the exudate resulting from the dysregulated inflammatory process with the intracapsular formation of late seroma and hematoma. Lymphocyte consumption may be the reason for the statement by Keane et al ( 22 ) published in a review: “Curiously, a relative attenuation of circulating T-helper cells may occur in the first couple days following placement of a textured, but not smooth breast implant. While each of these studies proposes a different ‘trigger’, chronic inflammation is the common thread and is the most likely facilitator of malignant transformation to BIA-ALCL.” Despite the original article demonstrating more significant postoperative leukopenia in patients with textured implants when compared with smooth implants ( 23 ), we published a case report of BIA-ALCL in a patient who had SIGBIC and signs of gel bleeding in both breasts, with leukopenia in preoperative exams.…”

“…The closing seal is important because it is the area of most significant silicone leakage, with direct exposure of the silicone to the fibrous capsule ( Figure 3 ). In a review by Keane et al ( 22 ), the authors stated intraoperative findings of BIA-SCC that include fungating breast capsule masses with granulomatous and keratinized debris contained within a viscous, turbid seroma fluid. The article also discussed that the malignancy arises from the posterior aspect of the implant capsule.…”

Role of cell block immunohistochemistry in early diagnosis of lymphoma.

“…mediastinal, retroperitoneal or ocular lymphadenopathy 7 , where fine needle aspiration cytology is considered to be the method of choice. But accurate classification is not possible without immunocytochemistry 8 . Cell block IHC can be considered for early diagnosis of lymphoma for better treatment plan in these cases 9 .…”