In Reply We thank Altundag and Fleury for their interest in our article.1 The pathogenesis of this rare disease entity is still under investigation. However, all cases with detailed implant history have been linked to textured implants.
Altundag commented on the lack of detailed information about the clinicopathological characteristics of the patients’ breast cancers as well as the chemotherapy and radiation therapy they received. This was a systematic review of the literature, and therefore, we were limited to previously published data. The vast majority of articles did not list any information about the clinicopathological details of the primary breast cancer and treatment. If information was reported, it was very basic (ie, stated that the patient underwent chemotherapy). We agree with Altundag that some breast cancer subtypes, such as triple-negative or human epidermal growth factor receptor 2–positive breast cancer, are more immunogenic. However, to our knowledge, there are no widespread data to suggest that these patients are more likely to develop breast implant–associated anaplastic large cell lymphoma (BIA-ALCL). Additionally, a significant number of patients with BIA-ALCL had cosmetic surgery without any history of breast cancer. This accounted for 46% of patients in our review article.1
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Leberfinger AN, Mackay DR, Ravnic DJ. Additional Risk Factors for Breast Implant–Associated Anaplastic Large Cell Lymphoma—Reply. JAMA Surg. 2018;153(8):781–782. doi:10.1001/jamasurg.2018.1122
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