American Association of Plastic Surgeons

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Contacting 1,340 Patients at Risk for BIA-ALCL: An update on patient decisions after one year
John M. Roberts, MD, Logan W. Carr, MD, Allison Jones, BSN, Amber Schilling, PharmD, MEd, Donald R. Mackay, MD, John D. Potochny, MD.
Penn State Hershey Medical Center, Hershey, PA, USA.

Purpose
Breast implant-associated anaplastic large cell lymphoma’s increasing incidence and associated mortality has become alarming. However, many patients remain unaware of their risk for BIA-ALCL and may overlook early warning signs of the cancer. The authors aim to contact all breast implant patients at a single institution to educate them on the disease and provide screening and treatment as indicated.
Methods
All patients who had breast implants placed at Penn State Hershey Medical Center from 1979 to November 2017 were mailed a letter to describe BIA-ALCL and to encourage a follow-up visitation. Patient information regarding demographics, implant type, the number of calls and follow up visits, physical exam findings, as well as patient decisions after being informed of the disease were recorded prospectively.
Results
One thousand two hundred and eighty-four letters were mailed with 1,020 (79.4%) to patients with smooth implants and 264 (20.6%) with textured implants. Despite FDA recommendations for close observation alone, preliminary data indicates that greater than 10% of textured implant patients will undergo additional surgery to have their implants removed or exchanged. Patient decisions after one year since project implementation are assessed.
Conclusions
Informing patients at risk for breast implant-associated anaplastic large cell lymphoma is an important endeavor. Patients educated on the disease will likely be diagnosed and treated earlier which can prevent the need for adjuvant chemotherapy and/or radiation as well as
decrease mortality. We provide a method, supporting documents and one-year data analysis to help other institutions contact their breast implant patients.


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