Clinical Implications of BIA-ALCL: Survey of the American Society of Plastic Surgeons
Logan Carr, MD, John Roberts, MD, John Potochny, MD.
Penn State Milton S Hershey Medical Center, Hershey, PA, USA.
Background: Breast implant use is at an all-time high. The FDA estimates as many as 10 million women worldwide currently have breast implants. BIA-ALCL is a malignancy associated with textured breast implants. While previously thought to be extremely rare, emerging evidence reveals a much higher incidence. Many studies have examined the etiology, incidence, and treatment of BIA-ALCL, but it is unclear how this information is being utilized. The purpose of this study is to examine how practicing plastic surgeons are integrating this new information in their clinical decision making.
Methods: A questionnaire was developed in conjunction with the ASPS BIA-ALCL subcommittee. The survey was sent to all members. In addition to surgeon demographic data, questions focused on if and how the increased awareness of BIA-ALCL has changed the individual surgeon's practice.
Results: Six hundred and seven ASPS members completed the survey. Respondents mainly work in private practice (76%) and 42.6% have been practicing for at least twenty years. Most (83.4%) believe BIA-ALCL is a malignancy, while some (5%) still doubt its existence. Almost 80% believe the incidence is less than 1/30,000, with 13% of those reporting the probability as one in a million. Interestingly, almost 60% of respondents want surgeons who place textured implants to complete online training regarding the diagnosis and treatment of BIA-ALCL. During patient consultation, 61% routinely discuss BIA-ALCL, while 26% discuss only if using textured implants. Conversely, 13% do not mention BIA-ALCL regardless of surface type. When completing an informed consent, 55% always include BIA-ALCL as a risk, 14% include it if using textured implants, and 25% do not include it as a risk because of the low incidence.
Considering the increased risk of BIA-ALCL, 47.7% of plastic surgeons have switched to smooth implants exclusively. Smooth implants are favored by 62.5% in reconstructive breast surgery, and 90.25% in cosmetic breast surgery. Postoperatively, 35% of surgeons follow their breast implant patients for only one year, and 34% follow patients for over 10 years. For patients who already have breast implants, 87% of surgeons have not attempted to update them concerning BIA-ALCL. If surgeons choose to inform their patients, most discuss it at a scheduled appointment (64%).
Conclusion:
Although BIA-ALCL is hundreds of times more common than originally thought, some plastic surgeons continue to use textured implants, omit the risk during informed consent, have abbreviated postoperative follow-up, and do not inform their established patients of their increased risk.
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