Risk of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) in Patients with Temporary Exposure to Textured Tissue Expanders: an analysis of 3310 patients
Cayla McKernan MS, PA-C1, Jonas A. Nelson, MD, MPH1, Robyn N. Rubenstein, MD2, Kathryn Haglich, BS, MS, Stefan Dabic MPH, Babak Mehrara MD, Joseph Disa MD, Peter Cordeiro MD, Colleen M. McCarthy, MD, MS, Ricky Poulton
Memorial Sloan Kettering Cancer Center, New York, NY
Background: The association of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) with exposure to textured devices has been well-established. The incidence of BIA-ALCL in patients with textured breast implants has been increasingly studied in the last two decades; however, the risk of BIA-ALCL in patients who have had transient exposure to a textured tissue expander (TE) has not been as well-documented. The aim of this study is to assess the incidence and risk of BIA-ALCL in patients who have had temporary exposure to a textured device in the form of a tissue expander with subsequent smooth implant placement.
Methods: A retrospective cohort study was performed including female patients at a National Cancer Institute designated institution who underwent breast reconstruction with placement of a textured tissue expander between 1995-2016 with subsequent exchange to a smooth permanent implant to assess for development of BIA-ALCL. Development of BIA-ALCL was noted via an institutional case database. All patients with any exposure to textured implants after exchange were excluded. Follow-up time was determined by last documented visit at our institution. We calculated summary statistics for exposure time and follow-up intervals.
Results: A total of 3271 patients (median age 47) underwent mastectomy with temporary exposure to a textured tissue expander with eventual exchange for a smooth implant, totaling 5096 individual textured tissue expanders for either unilateral or bilateral reconstruction. The median time of textured TE exposure for the cohort was 5.75 months (0.5 -77.6 months). The median follow-up time was 6.6 years with a minimum follow-up time of 2 months and a maximum follow-up time of 25.7 years. No cases of BIA-ALCL were identified in the cohort at any time.
Conclusion: The risk of BIA-ALCL with short term exposure to temporary textured tissue expanders followed by smooth implant exchange is likely lower than risk for textured permanent implants. While longer patient follow-up is needed, this information can be used when counseling patients with smooth implants who had previous exposure to textured TEs and are concerned about their risk of BIA-ALCL. Furthermore, it can be used in dialogue regarding the continued utility of textured tissue expander use.
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