The Inflammatory Effects of Breast Implant Particulate Shedding: Comparison With Orthopedic Implants

Hallab, Nadim J.; Samelko, Lauryn; Hammond, Dennis

doi:10.1093/asj/sjy335

Cited by 51 publications

(38 citation statements)

References 111 publications

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“…Similar to BIA-ALCL, case reports of CD30-positive ALK-negative ALCL in patients with dental [ 50 ], gastric lap band [ 51 ], gluteal [ 52 ], and silicone-containing port device implants [ 53 ] have subsequently emerged [ 48 ]. While theories of lymphomagenesis by a proposed mechanism of mechanical friction have been suggested [ 54 ], evidence remains limited in light of the fact that the capsular-implant interface is typically “slick”.…”

Section: Etiology Of Bia-alclmentioning

confidence: 99%

“…A study of particles present around failed silicone orthopedic implants identified billions of particles less than 1 μm in size [ 57 ]. Failure of metal and polyethylene implants is linked to an innate immune system response in which activated macrophages become overwhelmed with particulate wear debris and subsequently release inflammatory factors that indirectly promote a T-cell response by lymphocyte chemotaxis and replication [ 54 , 58 ]. Such a mechanism—involving the capture of silicone-containing particles by macrophages followed by macrophage activation, cytokine production, and apoptosis—has been proposed for silicone-induced granuloma of the breast implant capsule [ 59 ].…”

Section: Etiology Of Bia-alclmentioning

confidence: 99%

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Etiology of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): Current Directions in Research

Deva

Turner

Kadin

et al. 2020

Cancers

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Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a CD30-positive, anaplastic lymphoma kinase-negative T-cell lymphoma. Where implant history is known, all confirmed cases to date have occurred in patients with exposure to textured implants. There is a spectrum of disease presentation, with the most common occurring as a seroma with an indolent course. A less common presentation occurs as locally advanced or, rarely, as metastatic disease. Here we review the immunological characteristics of BIA-ALCL and potential triggers leading to its development. BIA-ALCL occurs in an inflammatory microenvironment with significant lymphocyte and plasma cell infiltration and a prominent Th1/Th17 phenotype in advanced disease. Genetic lesions affecting the JAK/STAT signaling pathway are commonly present. Proposed triggers for the development of malignancy include mechanical friction, silicone implant shell particulates, silicone leachables, and bacteria. Of these, the bacterial hypothesis has received significant attention, supported by a plausible biologic model. In this model, bacteria form an adherent biofilm in the favorable environment of the textured implant surface, producing a bacterial load that elicits a chronic inflammatory response. Bacterial antigens, primarily of Gram-negative origin, may trigger innate immunity and induce T-cell proliferation with subsequent malignant transformation in genetically susceptible individuals. Although much remains to be elucidated regarding the multifactorial origins of BIA-ALCL, future research should focus on prevention and treatment strategies, recognizing susceptible populations, and whether decreasing the risk of BIA-ALCL is possible.

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Section: Etiology Of Bia-alclmentioning

confidence: 99%

Section: Etiology Of Bia-alclmentioning

confidence: 99%

Etiology of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): Current Directions in Research

Deva

Turner

Kadin

et al. 2020

Cancers

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“…Authors have postulated that all implants produce a variable degree of implant debris over time. 44 In fact, friction between the implant surface and the overlying tissues can cause chronic inflammation. Friction and wear can lead to the breaking off of tiny silicone particles from the implant surface, which can also aggravate inflammation through macrophage digestion.…”

Section: Introductionmentioning

confidence: 99%

Breast Implant Surfaces and Their Impact on Current Practices: Where We Are Now and Where Are We Going?

Munhoz

Clemens

Nahabedian

2019

Plastic and Reconstructive Surgery - Global Open

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Summary:Most commercially available breast implants feature some degree of elastomer surface modifications to increase surface roughness, in part because several clinical series have demonstrated positive outcomes from texturizing. However, the literature shows that textured implants support higher rates of bacterial growth, and there is a clear association between increased bacterial contamination and host response in vivo, such as capsular contracture. Furthermore, the infectious theory related to bacterial contamination has recently been described as a potential cause in the etiology of anaplastic large-cell lymphoma. Recent research has focused on the physiology of breast implant surfaces advances and how they interact with the body, creating new surface technologies which have the potential to affect all aspects of breast surgery. Understanding how surface properties affect inflammatory cell response will be essential in designing implants that can provide an esthetic solution while also minimizing long-term clinical complications. This special topic highlights the current knowledge on silicone implant surfaces, as well as innovations that have shaped and will continue to change the silicone breast implant industry in the future. It also provides an overview of the principal surfaces that exist and may find clinical applications in esthetic and reconstructive breast surgery. As additional advances emerge, objective tools will be required to evaluate the different surfaces available on the market, along with the long-term efficacy of new technologies.

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“…Multiple factors have been implicated 14 (14), including the use of textured surface implants, a local inflammatory reaction, 15 and impaired host immunity by mutations in the JAK3-STAT pathway and MYC/TP53 deregulation. 16 – 18 The average time from implant to lymphoma development is approximately 9 years. 19 The most frequent clinical manifestation is the presence of limited effusion (seroma), which occurs in almost 70% of cases.…”

Section: Introductionmentioning

confidence: 99%

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

Gomez¹,

Abad

Duque

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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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.

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The Inflammatory Effects of Breast Implant Particulate Shedding: Comparison With Orthopedic Implants

Cited by 51 publications

References 111 publications

Etiology of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): Current Directions in Research

Etiology of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): Current Directions in Research

Breast Implant Surfaces and Their Impact on Current Practices: Where We Are Now and Where Are We Going?

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

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