This is out of the Aesthetic Journal. It was a retrospective study looking at 248 cases of BIA ALCL. This isn’t adding a ton to what we know- macrotextured implants are highest risk, many women present with seroma- but I always learn some tidbits, which I did here.
What did they find?
- The implants were almost a 50/50 split for aesthetic breast augmentation vs. breast reconstruction (52% vs 48%)
- Macrotexturing was 73.8%. Why is this important? It means it wasn’t only one brand of implant.
- Seroma was seen in 83% Why is this important? It means all of them did not have a seroma.
- ALCL developed on average 129 months after implantation, with the peak at 84 months.
- Mean age of implant was 42 years. Mean age of diagnosis of ALCL was 53.
- Older patients had shorter time to presentation. The postulate this is due to faster progression, not higher incidence.
- BRCA and TP53 mutations had higher risk of ALCL/ shorter duration until presentation.
When they looked at the patients, 99% did not have ADM used (though they state this is “far from suggesting any protective role, but their use is relatively novel… and not used in cosmetic cases.”), 97% had no history of infection, 88% had no rupture, 82% no capsular contracture, 72% no history of implant replacement, 78% no genetic predisposition. 65% had a history of previous capsular contracture.
One thing in the study was they said that implant replacement reduces ALCL occurrence. They advocate for implant replacement not only to decrease the risk of capsular contracture and implant rupture, but they state it lowers the ALCL rates.
My thoughts?
If you have BRCA or TP53, and you have a textured implant, you are at higher risk for ALDL. If you have a textured implant, particularly if the Allergan/McGhan/Biocell macrotexturing, consider exchanging it. All implants need to be replaced at some point. If you have a textured implant, err toward doing it sooner than later. That 10 year mark seems to be the spike in occurrence.