Risk of breast implant associated anaplastic large cell lymphoma (BIA-ALCL) in a cohort of 3546 women prospectively followed long term after reconstruction with textured breast implants Journal Article
| Authors: | Cordeiro, P. G.; Ghione, P.; Ni, A.; Hu, Q.; Ganesan, N.; Galasso, N.; Dogan, A.; Horwitz, S. M. |
| Article Title: | Risk of breast implant associated anaplastic large cell lymphoma (BIA-ALCL) in a cohort of 3546 women prospectively followed long term after reconstruction with textured breast implants |
| Abstract: | Background: The risk of BIA-ALCL for patients with textured breast implants has been estimated between 1/2832 and 1/30,000 women. Existing studies estimating the numbers exposed and at risk, may have under reported cases, and/or lacked comprehensive follow-up. Our objective is to determine the risk of BIA-ALCL in a defined cohort of patients reconstructed with macro-textured breast implants and consistently followed long-term. Methods: A prospective cohort study was conducted in patients who underwent breast reconstruction by a single surgeon at Memorial Sloan Kettering Cancer Center (MSKCC) from December 1992 to December 2017. Major events related to implants were prospectively recorded. We identified cases of BIA-ALCL by cross-checking clinical, pathology and external records data. Patients were followed until lymphoma occurrence or last follow-up. The primary outcomes were incidence rate per person-years and cumulative incidence. Results: From 1992 to 2017, 3546 patients underwent 6023 breast reconstructions, mainly after breast cancer removal, or contralateral prophylactic mastectomy, using macro-textured surface expanders and implants. All reconstructions were performed by a single surgeon (PGC). Median follow-up was 8.1 years (range, 3 months – 30.9 years). Ten women, 1/354, developed ALCL after a median exposure of 11.5 years (range, 7.4–15.8 years). Overall risk of BIA-ALCL in our cohort is 1/355 women or 0.311 cases per 1000 person-years (95% CI 0.118 to 0.503). Discussion: This study, the first to evaluate the risk of macro-textured breast implants from a prospective database with long term follow-up, demonstrates that the incidence rate of BIA-ALCL may be higher than previously reported. These results can help inform implant choice for women undergoing breast reconstruction. © 2020 British Association of Plastic, Reconstructive and Aesthetic Surgeons |
| Keywords: | adult; cancer chemotherapy; aged; cancer surgery; major clinical study; cancer risk; positron emission tomography; follow up; cancer incidence; prospective study; breast cancer; cohort analysis; breast reconstruction; graft necrosis; histology; axillary lymph node; lymphoma; seroma; cellulitis; prophylactic mastectomy; clinical outcome; anaplastic large cell lymphoma; pectoral muscle; human; female; priority journal; article; internal mammary lymph node; breast implant rupture; breast radiotherapy; bia-alcl; macro-textured |
| Journal Title: | Journal of Plastic Reconstructive and Aesthetic Surgery |
| Volume: | 73 |
| Issue: | 5 |
| ISSN: | 1748-6815 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2020-05-01 |
| Start Page: | 841 |
| End Page: | 846 |
| Language: | English |
| DOI: | 10.1016/j.bjps.2019.11.064 |
| PUBMED: | 32008941 |
| PROVIDER: | scopus |
| PMCID: | PMC7247945 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 July 2020 -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
Related MSK Work