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October 23, 2019

Breast Implant–Associated Anaplastic Large Cell Lymphoma: Real, Rare, but Avoidable

Author Affiliations
  • 1Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
  • 2Division of Oncology, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
  • 3Department of Pathology and Immunology, Washington University School of Medicine in St Louis, St Louis, Missouri
JAMA Surg. 2020;155(1):3-4. doi:10.1001/jamasurg.2019.3154

Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL), first reported in 1997, is recognized in the 2016 edition of the World Health Organization as a subtype of the peripheral T-cell lymphomas.1 Whether they are filled with saline or silicone gel, the shells of breast implants can have smooth or textured surfaces. A textured-surface breast implant is associated with every case of BIA-ALCL where the entire breast implant history of the patient is known. Estimates of the lifetime risk of BIA-ALCL vary, ranging from 1 in 1000 to 1 in 30 000 patients with textured breast implants. As of May 2019, the American Society of Plastic Surgeons reports 722 distinct cases worldwide.2 On May 2, 2019, the US Food and Drug Administration (FDA),advocated for “strengthening the evidence generated to help inform future regulatory actions” but did not restrict access to any implants. By contrast, the National Agency for Medicine and Health Products of France banned textured breast implants from several manufacturers on April 2, 2019. Health Canada suspended the licenses of available macrotextured breast implants on May 28, 2019. Based on the available evidence, and the expectation that plastic surgeons will provide comprehensive information for patients to make an informed decision, we agree with the FDA’s measured approach.

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