The Macrotextured Implant Recall: Breast Implant–Associated-Anaplastic Large Cell Lymphoma Risk Aversion in Cosmetic and Reconstructive Plastic Surgery Practices

Abstract

Background Since the association between anaplastic large cell lymphoma (ALCL) and textured breast implants has led to the recall of Allergan Biocell (Irvine, CA, USA) devices, plastic surgeons have been faced with the challenge of caring for patients with these implants in situ. Cosmetic and reconstructive surgeons have been contacting patients with these implants in order to encourage them to follow up and discuss the most appropriate risk reduction strategies. Objectives To evaluate patient concerns about the risk of breast implant associated ALCL and compare management differences between cosmetic and reconstruction patients. Methods A retrospective review was performed of 432 patients with macro textured implants that presented to clinic after being contacted (121 reconstructive and 311 cosmetic). These records were analyzed for their presenting concerns, surgery wait times and management plans. Statistical analysis was performed to compare the cohorts and odds ratios were computed to determine the association between patient concerns and their choice of management. Results After consultation, 59.5% of the reconstruction cohort and 49.5% of the cosmetic cohort scheduled implant removal or exchange. The reconstructive population had a higher rate of ALCL concern (62.7%), however both cohorts had a significant odds ratio demonstrating an expressed fear of ALCL likely contributed to their subsequent clinical management (1.66 OR cosmetic, 2.17 OR reconstructive). Conclusions Although the risk of ALCL appears to be more concerning to the reconstructive population, both cohorts were equally motivated to have their implants removed. Informing patients about their ALCL risk is crucial to ensure a patient supported risk reduction plan.

A prospective randomized clinical trial to assess antibiotic pocket irrigation on tissue expander breast reconstruction

“…Further, while we characterized microbial communities over time, several sample types, and conditions of malignancy and antibiotic exposure employing metataxonomic, imaging, and culture techniques with clinical translation, future directions should employ functional analyses with metagenomics and metabolomics. In addition, it is feasible that the evolution of reconstructive techniques and devices to include prepectoral reconstruction ( 87 ), a shift away from macrotextured implants ( 88 , 89 ), and alternative antiseptics and antibiotics used in pocket irrigation may also impact the interaction between bacteria, host, and device ( 33 , 56 , 90 ). Lastly, while all of our study specimens were procured in a sterile operating setting using chlorhexidine skin preparation and perioperative intravenous antibiotics followed by immediate transfer from the patient to 200 proof ethanol in the operating room, it is feasible that some became contaminated during device retrieval ( 91 ).…”

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

“…All verified cases of BIA-ALCL with complete implant history have been exclusively discovered in patients with a history of textured implants, many of which have been recalled, or in some countries banned, due to this association ( 26 – 28 ). Of the 1,130 medical device reports of ALCL, 37 cases were found in patients with smooth implants.…”

Breast implant surface topography triggers a chronic-like inflammatory response

“…Albeit genetic factors may contribute to the onset of this lymphoma ( Tevis et al, 2019 ; Laurent et al, 2020 ), there is growing evidence that the chronic inflammatory state associated with textured prostheses plays a role in fostering a pro-tumoral environment ( Mempin et al, 2021 ; Mankowski et al, 2022 ). Recent animal studies involving mice and rabbits have highlighted a direct correlation between the inflammation predominantly mediated by T cells and the roughness of the implant surface ( Doloff et al, 2021 ).…”