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Smoldering Multiple Myeloma Improvement Following Textured Breast Implant Removal
Cristin L. Coquillard, David E. Kurlander, Lois Teston, Tobias Long
Case Western Reserve University/University Hospitals CMC
2020-02-15
Presenter: Cristin Coquillard
Affidavit:
Cristin Coquillard
Director Name: Anand Kumar
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
PURPOSE: A link between breast implants and multiple myeloma was first proposed in 1994, leading some to hypothesize that capsule formation caused polyclonal inflammatory reactions that could convert to malignant monoclonal lymphocytic activation. Here we report a patient who experienced improvement of her multiple myeloma markers after removal of textured saline breast implants.
METHODS: A 53-year-old female in 2010 underwent bilateral mastectomies and reconstruction with textured saline implants for bilateral multifocal breast cancer. Eight years later, after workup for anemia, arthralgias, fatigue, hair loss, and difficulty concentrating, she was diagnosed with monoclonal gammopathy of undetermined significance (MGUS), a multiple myeloma precursor. MGUS quickly progressed to a more aggressive sub-type called smoldering myeloma. At this time, the patient presented to the senior plastic surgeon with concern for breast firmness and questioned if her implants were associated with the plasma cell dyscrasia and symptoms.
RESULTS: As treatment for Baker grade 2 capsular contracture, the patient underwent bilateral total capsulectomies and implant removal. Postoperatively, the patient's serum and bone marrow light chain ratios improved. At 1 year follow up, the patient's laboratory values remain improved, all her symptoms have resolved, and she does not require any medical treatment. She remains under close hematologic surveillance.
CONCLUSION: Interest in the relationship between breast implants and multiple myeloma has weaned in recent years. In the context of recent efforts to understand breast implant associated anaplastic large cell lymphoma, it may be time to also revisit the association of textured breast implants with myeloproliferative disorders.
