Surgical Management And Long-Term Outcomes Of BIA-ALCL: A Multi-Disciplinary Approach
Joshua Vorstenbosch, MD, PhD1, Paola Ghione, MD2, Steven M. Horwitz, MD3, Peter G. Cordeiro, MD3, Jonas A. Nelson, MD, MPH3, Colleen M. McCarthy, MD3.
1McGill University, Montreal, QC, Canada, 2Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA, 3Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Purpose: Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a rare subtype of ALCL that arises as a seroma or a mass in the capsule surrounding textured breast implants. However, collections of cases usually come from large groups of institutions or countries, with different approaches regarding surgery and treatment. Here we describe a cohort of 18 cases undergoing implant removal and capsulectomy and followed at Memorial Sloan Kettering Cancer Center (MSKCC).
Methods: We retrospectively analyzed all the cases of women with breast implants undergoing implant removal and capsulectomy for BIA-ALCL at MSKCC from January 2011 to June 2020.
Results: Median age at diagnosis was 57 (SD=10) years following a median implant exposure of 11 (SD=6) years. All known implants were macrotextured. Sixteen patients (89%) had implants placed for breast cancer reconstruction. Patients presented with clinical effusion in 78% of cases and a mass in 17% of cases, and 83% of patients presented with Stage 1 BIA-ALCL. Patients were followed for a median of 37.7 months (SD=35 months) after diagnosis. There was one recurrence which as treated with total capsulectomy. All patients now remain disease-free and no patients died of ALCL.
Conclusions: In this cohort of BIA-ALCL patients surgically treated and followed at a single institution, we confirm the importance of adequate surgery (bilateral implant removal and total capsulectomy) in patients presenting with seroma-confined disease. This dataset reinforces the high rates of progression free and overall survival when diagnosis is identified and treatment performed in those with limited stage disease.
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