Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL): a collaborative effort for diagnosis and treatment

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a very uncommon disease that has only recently appeared in the literature. Based on data from medical literature reports, the US Food and Drug Administration (FDA) estimates the lifetime risk of this distinct cancer to be between 1 in 3,817 to 1 in 30,000 in patients with textured breast implants. Due to the high incidence of breast implantation for both cosmetic and reconstructive reasons, it is important that general surgeons are aware of this clinical entity so that they will involve their plastic surgeon colleagues early in the management of this cancer. Our patient is a 37-year-old female who presented to an outpatient plastic surgery clinic in 2008 with fluctuation in the size of her left breast 16 years after cosmetic bilateral augmentation mammoplasty with saline Biocell textured implants. Initial suspicion for seroma was managed by surgical drainage with pathologic investigation showing atypical cells with high nucleus to cytoplasm ratio. Symptoms appeared to resolve following drainage until the patient discovered a mass in the same breast 7 years later. After immunohistochemical (IHC) staining of the excised specimen demonstrated positivity for CD30 with negative ALK-1, lymphoma was suspected, and surgical oncology was involved in management. PET/CT imaging demonstrated localized disease and isolated surgical management was recommended for our patient. Excision of the left breast capsule with removal of left breast implant was performed and pathology showed features characteristic for a T-cell anaplastic large cell lymphoma (T-ALCL). Shortly thereafter, local recurrence was evident requiring mastectomy, capsulectomy, and chemotherapy. The patient has since completed breast reconstruction and is currently in remission from BIA-ALCL. There are many areas of further investigation required to reduce morbidity in treatment of this disease. In the early period of investigation into this new unique cancer diagnosis, it is important to utilize a comprehensive team approach to collaborate on the optimal treatment for each patient with the diagnosis of BIA-ALCL.