American Association of Plastic Surgeons

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Gluteal Implant Associated ALCL: No Longer Only Breasts
Orr Shauly, BS1, Daniel J. Gould, MD, PhD2, Imran Siddiqi, MD2, Ketan M. Patel, MD2, Joseph Carey, MD2.
1Keck School of Medicine of USC, Los Angeles, CA, USA, 2Keck Hospital of USC, Los Angeles, CA, USA.

Purpose - In the past decade, there have been a large number of publications focused on BIA-ALCL, but there has yet to be a reported case outside the breast. Here, we describe a unique instance of gluteal implant associated-ALCL (GIA-ALCL) in a middle-aged woman. The purpose of this study is to demonstrate that all patients undergoing implantation of textured silicone implants are at risk of developing ALCL, and to provide evidence for the diagnosis of GIA-ALCL.
Methods - The clinical course and diagnosis of ALCL was described in the case of a patient with ALCL associated with textured gluteal implants placed one year prior.
Results - The patient received bilateral textured silicone gluteal implants only a year prior to her diagnosis. In early 2017, the patient presented to the Plastic and Reconstructive Surgery department at our institution with ulceration at the site of her gluteal implants. Her condition deteriorated before explanation could be performed. Biopsy of a left lung mass demonstrated “hallmark” cells of ALCL (“horseshoe” nuclei). The diagnosis was verified by immunohistochemical testing that revealed expression of CD30, CD4, CD43, BCL6, Perforin, and Ki67.
Conclusions - It is imperative that all physicians recognize that patients with textured silicone implants other than breast implants may be at risk of ALCL. Immunohistochemical analysis of aspirated seroma fluid from the implant capsule is still currently the most sensitive screening and diagnostic tool available for assessing patients with textured implants that present with late-onset seroma or other cardinal signs of implant associated ALCL.


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