Anaplastic large T-cell lymphoma and breast implants: a review of the literature

Plast Reconstr Surg. 2011 Sep;128(3):651-61. doi: 10.1097/PRS.0b013e318221db81.

Abstract

Background: Anecdotal reports and one case-control study suggested an association, without evidence of causation, between breast implants and anaplastic lymphoma kinase-negative anaplastic large T-cell lymphoma (ALCL), a rare non-Hodgkin's lymphoma. This review summarizes the published evidence, including case reports and epidemiologic studies.

Methods: A PubMed search limited to English language articles was conducted using the search terms "breast implant" and "lymphoma," "primary T-cell breast lymphoma," or "breast implant and ALCL" to identify all published cases of breast-associated ALCL.

Results: A total of 18 publications were retrieved describing 27 cases of ALCL in breast implant recipients. Breast-associated ALCL occurred in women with and without implants. Approximately 78 percent of cases (21 of 27) were CD30 anaplastic lymphoma kinase-negative, with an indolent clinical course. Both saline- and silicone-filled devices were identified; however, implant style and surface texture were largely unreported. The tumor stage at diagnosis was I in 16 of 27, II or higher in seven of 27, or unreported in four of 27. No prospective epidemiologic study has linked implants and ALCL; however, a single case-control study in Dutch women reported increased odds of association between ALCL and implants, and an estimated frequency of one in 1 million women with and without breast implants.

Conclusions: An association, without evidence of causation, was reported between breast implants and ALCL. Further study is required to confirm this association. Breast-associated ALCL occurred rarely in women with and without breast implants and had a primarily indolent clinical course, which may provoke a revision of the World Health Organization nomenclature for lymphoma; however, aggressive clinical behavior was also reported. The cases of ALCL were not confined to a specific type of implant.

Clinical question/level of evidence: Risk, V.

Publication types

  • Review

MeSH terms

  • Aged
  • Anaplastic Lymphoma Kinase
  • Biomarkers, Tumor / analysis
  • Breast Implants / adverse effects*
  • Breast Neoplasms / epidemiology
  • Breast Neoplasms / etiology*
  • Case-Control Studies
  • Causality
  • Cross-Sectional Studies
  • Female
  • Humans
  • Lymphoma, Large-Cell, Anaplastic / epidemiology
  • Lymphoma, Large-Cell, Anaplastic / etiology*
  • Middle Aged
  • Neoplasm Staging
  • Odds Ratio
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology*
  • Prosthesis Design
  • Receptor Protein-Tyrosine Kinases / analysis
  • Risk Factors

Substances

  • Biomarkers, Tumor
  • ALK protein, human
  • Anaplastic Lymphoma Kinase
  • Receptor Protein-Tyrosine Kinases