Timing and Technique of Reconstruction following Breast Implant Associated Anaplastic Large Cell Lymphoma
Gregory A. Lamaris, MD, PhD, Charles E. Butler, MD, Roberto N. Miranda, MD, Kelly Hunt, MD, Mark W. Clemens, MD.
MD Anderson Cancer Center, Houston, TX, USA.
PURPOSE: Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is a rare T-cell lymphoma arising around textured breast implants. Surgical resection with implant removal and capsulectomy are the standard of care. We sought to establish the optimal timing and technique for reconstruction following BIA-ALCL treatment.
METHODS: We retrospectively reviewed and prospectively enrolled all BIA-ALCL patients at a single tertiary care cancer center from 1998-2017. Demographics, treatment, reconstruction, pathology staging, patient satisfaction, and oncologic outcomes were reviewed.
RESULTS: 43 consecutive BIA-ALCL patients referred to our institution were reviewed, and 12 received reconstruction. 8(66%) patients received immediate reconstruction and 4(33%) patients received delayed reconstruction. Median age was 49 years and disease stage at presentation was IA(45%), IC(18.2%) IIA(18.2%), IIB(8.3%), III(8.3%), and IV(8.3%). Patients were managed with device explantation/capsulectomy(100%) neoadjuvant(8.3%), adjuvant chemotherapy(18.2%). Types of reconstruction included smooth implants(58.3%), mastopexy(25%), DIEP flaps(8.3%), and fat grafting(8.3%). Outcomes included no surgical complications, 83% complete remission, alive with stable disease(8.3%), and progression to widespread bone metastasis(8.3%). 11 patients were highly satisfied with reconstruction and one patient regretted immediate smooth implants.
CONCLUSION: Breast reconstruction following BIA-ALCL management can be performed with acceptable complications if complete surgical ablation is possible. Immediate reconstruction requires is reserved for disease confined to capsule on preoperative PET/CT scan. Genetic predisposition and bilateral cases suggest BIA-ALCL patients should not receive textured implants. Autologous options are preferable for implant adverse BIA-ALCL patients. Patients with extensive disease at presentation should be considered for 3-6 month delayed reconstruction with interval PET/CT evaluation.
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