A Prospective Approach to Inform and Treat 1340 Patients at Risk for BIA-ALCL

Plast Reconstr Surg. 2019 Jul;144(1):46-54. doi: 10.1097/PRS.0000000000005703.


Background: The increasing incidence and associated mortality of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has become alarming. However, many patients remain unaware of their risk for BIA-ALCL and may overlook early warning signs of the cancer. The authors aim to contact all breast implant patients at a single institution to educate them on the disease and provide screening and treatment as indicated.

Methods: All patients who had breast implants placed at Penn State Hershey Medical Center from 1979 to November of 2017 were mailed a letter to describe BIA-ALCL and to encourage a follow-up visit. Patient information regarding demographics, implant type, the number of calls and follow-up visits, physical examination findings, and patient decisions after being informed of the disease were recorded prospectively.

Results: One thousand two hundred eighty-four letters were mailed to 1020 patients (79.4 percent) with smooth implants and 264 patients (20.6 percent) with textured implants. Seventy-six calls were received and 100 patients (84 smooth and 16 textured) were evaluated within the first 2 months. Of the 16 patients with textured implants, nine are undergoing secondary surgery to remove or replace their textured device.

Conclusions: Informing patients at risk for BIA-ALCL is an important endeavor. Patients educated on the disease will likely be diagnosed and treated earlier, which can prevent the need for adjuvant chemotherapy and/or radiation therapy and decrease mortality. The authors provide a method, supporting documents, and preliminary data to help other institutions contact their breast implant patients at risk for BIA-ALCL.

MeSH terms

  • Aftercare
  • Breast Implantation / adverse effects
  • Breast Implants / adverse effects*
  • Breast Neoplasms / surgery
  • Device Removal / statistics & numerical data
  • Early Detection of Cancer / methods
  • Female
  • Humans
  • Lymphoma, Large-Cell, Anaplastic / etiology
  • Lymphoma, Large-Cell, Anaplastic / prevention & control*
  • Middle Aged
  • Patient Education as Topic / methods*
  • Prospective Studies
  • Prosthesis Design
  • Reoperation / statistics & numerical data
  • Retrospective Studies
  • Risk Factors