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Breast Implant-Associated Anaplastic Large Cell Lymphoma with Invasive Chest Wall Masses: Complex Considerations and Outcomes
Demetrius M. Coombs, MD; Rachel Aliotta, MD; Raymond Isakov, MD
The Cleveland Clinic
2020-02-14
Presenter: Demetrius Coombs, MD
Affidavit:
This project represents the original work of the resident.
Director Name: Steven L. Bernard, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) might occur in any patient with a history of breast implants, though particularly textured devices, and often presents as a spectrum of disease: from a simple late-onset seroma, to complex advanced locally aggressive disease with chest wall involvement. The combination of medical therapy and surgical implant removal with complete capsulectomy, or removal of the body's natural reactive tissue around the implant and all involved adjacent anatomic structures, is believed to be curative. In patients with advanced cases, however, and although generalized recommendations exist, no consensus exists regarding the appropriate medical and surgical management of those presenting with invasive disease. This brief case series describes two distinct presentations of rare invasive chest wall BIA-ALCL, both treated successfully, albeit somewhat differently, and subsequently discusses considerations and the current literature surrounding the treatment of advanced BIA-ALCL when the chest wall and adjacent structures are affected. We hope that our experience will contribute positively to the discourse regarding the treatment of these complex patients, stimulate additional research, and help ensure the excellent standard of care that already exists within the field of plastic and reconstructive surgery.
