American Association of Plastic Surgeons

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Squamous Cell Carcinoma And Breast Implants: A Contextualized Risk Assessment Through Epidemiology And Systematic Review
Fabio Santanelli di Pompeo, MD PhD1, Mark W. Clemens, MD PhD2, Guido Firmani, MD1, Christian Napoli, MD PhD1, Michail Sorotos, MD PhD1;
1Sapienza, Rome, Italy, 2MD Anderson Cancer Center University of Texas, Houston, TX, USA

PURPOSE: Squamous cell carcinoma (SCC) emerges adjacent to breast implants, termed breast implant-associated SCC (BIA-SCC), and from breast tissue itself, primary SCC of the breast (PSCCB). We collate all cases of BIA-SCC through a systematic review and juxtapose the associated risk for the US population with that of PSCCB and breast implant-associated anaplastic large cell lymphoma (BIA-ALCL).
METHODS: From September 2022 to June 2023, all publications on BIA-SCC were searched on Pubmed, Web of Science, Google Scholar and Cochrane Library to identify publications related to BIA-SCC. The risk denominators, derived from the US breast implant population and incorporating texture-specific implant data and female transgenders, catered to BIA-SCC and BIA-ALCL risk calculations, while the US female demographic served as the reference for PSCCB. Risks were calculated as the ratio of total cases to the at-risk population, per 100,000 individuals.
RESULTS: From 10,176 initial entries, 24 manuscripts were included, revealing 30 BIA-SCC cases, (25 into the US) with a risk of 1:171,505 individuals with breast implants, which was 3.46x less frequent than PSCCBs risk of 1:49,509 individuals, and 187.8x less frequent than BIA-ALCLs risk of 1:913 individuals with textured implants (P < 0.001).
CONCLUSION: This findings underscores the importance of a balanced perspective on breast implants-associated risks and highlights the necessity of evidence-based patient counseling. BIA-SCC remains very rare in the spectrum of breast implant-associated malignancies, particularly BIA-ALCL or PSCCB. By providing this context, surgeons and patients can approach breast augmentation decisions with well-informed clarity, ensuring choices are grounded in current epidemiology.
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