Anaplastic Large Cell Lymphoma (ALCL)

From the office of the President
25 September 2016
Dear Colleagues,Breast implants are used globally for augmentation mammoplasty and breast reconstruction after breast cancer surgeries.  It has become apparent that a disease called Anaplastic Large Cell Lymphoma (ALCL) may arise as a complication of implants. Providing information to patients before surgery, and following them after surgery, have become important strategies for plastic surgeons and patients everywhere.

ISAPS sent a survey to our National Secretaries in 78 countries in order to determine the occurrence of ALCL.  National Secretaries in 68 countries responded for which we are most appreciative.  Survey results revealed more than 500 cases of augmentation mammoplasty using breast implants in approximately 80% of these countries over 12 months. No occurrence of ALCL was reported in 58 of the 68 countries reporting. The countries with ALCL occurrences (shown in parentheses) were: Australia (8), Spain (17), Slovakia (2), New Zealand (3), South Africa (1), Canada (1), Argentina (1), Sweden (2), USA (more than 10), and Denmark (1). Considering the number of breast implants used in the world, the number of ALCL cases is extremely small; nevertheless, this disease exists and therefore, we must consider patients’ safety a top priority. Our findings are similar to other studies conducted by organizations like the Rand Corporation and related societies including ASPS and ASAPS.
Even though the etiology of ALCL in relation to implants is inconclusive at the moment, one should be aware of the possibility. Until the research catches up on this issue, certain measures are advisable.  Informed consent by patients undergoing breast implant surgery should clearly mention the rare possibility of complications with this type of disease and follow-up visits should be obligatory. As in the reports by ASAPS and ASPS, we also feel that education of physicians and patients is important when symptoms of ALCL occur.
Cases of late seroma and symptoms including pain, increased volume, and inflammation should be immediately investigated with Ultrasound and MRI and the opinion of an oncology colleague should be sought.
Early diagnosis, surgical removal of the implant with capsule, confirmation with CD 30 test and histology will save the situation and will lead to uneventful recovery of the patient.
We hope that determining why this type of disease occurs and how to prevent complications from implants, including ALCL, will lead to further improvements.