Revision 10 for 'Breast implant associated - anaplastic large cell lymphoma'

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Breast Implant Associated - Anaplastic Large Cell Lymphoma (BIA-ALCL)

Breast Implant Associated - Anaplastic Large Cell Lymphoma (BIA-ALCL) is a rare from of T-cell lymphoma which has primarily been associated with textured breast implants.  

Clinical presentation

Patients typically present with development of a late onset fluid collection surrounding the implant or less commonly after identification of a breast or axillary mass. Cases have been reported as early as 1 year after surgery and as late as 37 years post augmentation mammoplasty. The average time to clinical presentation is reported to be approximately 10 years post breast augmentation. 


The exact causative etiology has not been confirmed, however it is widely postulated that it is likely multifactorial in nature and due to a combination of factors including chronic inflammation, implant texturing and a subclinical infective pathology related to biofilm. The end result of the multiple insults malignant transformation of T-cells which are anaplastic lymphoma kinase negative and CD30 positive. 

Radiographic features


Sonography typically demonstrates a fluid collection between the breast implant and the capsule. Septa are often appreciated during the study. Ultrasound is reported to have a sensitivity of 84% and specificity of 75% for detecting effusion and sensitivity of 46% and specificity of 100% when detecting a BIA-ALCL mass. 




Lesions are fludeoxyglucose (18F) avid on positron emission tomography and the modality can be utilized to assess for systemic disease. 


Multidisciplinary management including radiology, hematology, oncology, plastic surgery and or surgical oncology input forms the basis of management. 

Management typically involves a complete en-bloc capsulectomy and explantation fo the prosthesis with patients subsequently receiving some form of chemotherapy and or radiotherapy depending on the extent of disease. 

Differential diagnosis

  • Seroma 
  • Liquified hematoma 
  • Primary breast cancer


The first case of BIA-ALCL was reported by Keech and Creech in the Journal of Plastic & Reconstructive Surgery in 1997. No reports of BIA-ALCL have been identified in the medical literature prior to the arrival of textured breast implants in the 1990s. 

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