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An Investigation of the Effect of the Silicone Shell on ALCL Cells in Seroma-like Conditions
Carly Askinas B.S.1, Nick Vernice A.B.1, Sabrina Shih B.A.1, Xue Dong M.D. Ph.D.1, George Corpuz B.A. B.S.1, Jason A. Spector M.D.1
1Laboratory of Bioregenerative Medicine & Surgery, Weill Cornell Medicine, New York, NY

Introduction: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare T-cell-derived lymphoma highly associated with textured device-based breast reconstruction. This prominent association led to the removal of Allergans textured implant from the market, while the exact etiopathogenesis remains unknown. Although less than 1,000 cases have been reported, it is estimated that 10 million people worldwide have a textured breast implant. Because BIA-ALCL commonly presents as a delayed seroma, we sought to interrogate the potential role of the silicone shell in altering cell proliferation in seroma-like fluid (media).
Methods: AbbVie Biocell textured and smooth breast implant shells were shaped to line 96-well plates. BIA-ALCL cell lines IL89 and TLBR2, and systemic ALCL cell line SUPM2 were plated at a density of 200,000 cells/mL within media. Two different types of media were tested low serum media (0.5% BSA) to limit the effect of growth factors and full serum media (20% FBS) to serve as a control. All cell lines were cultured in both conditions with and without implant shells. Fluorescent microscopy was performed over 10 days. Cell proliferation and cell size were quantified using ImageJ.
Results: IL89, TLBR2, and SUPM2 cultured in full serum media exhibited increased proliferation in all groups. Significantly higher cell counts with exposure to smooth and no implant, when compared to textured implants, were observed for all cell types in full serum media (p<0.05). Low serum conditions resulted in minimal change or a slight decrease in proliferation with an exception for TLBR2 without implant contact, which proliferated significantly (p<0.05), yet still less than all full serum groups. All cell types exhibited rounder morphologies in the presence of full serum, except with textured implant exposure. IL89 cell size was smallest in both full and low serum textured groups by day 10.
Conclusion: The presence of an implant, whether textured or smooth, influences the rate of ALCL proliferation in low and full serum media. The results we have shown emphasize that ALCL cell lines do not proliferate in the presence of textured implants even with the additional growth factors in full serum media, a very unexpected finding. One would hypothesize increased growth of ALCL cells with textured implant exposure because of their known association. To further elucidate this phenomenon, ongoing studies are investigating BIA-ALCL progenitors, T cells.


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