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Risk of Lymphomas of the Breast Following Postmastectomy Implant-Based Breast Reconstruction
Dylan K. Kim
*1, Lauren S. Lowe
1, Christine H. Rohde
1, David Horowitz
2, Alfred Neugut
3, Connor Kinslow
21Division of Plastic and Reconstructive Surgery, Columbia University Irving Medical Center, New York, NY; 2Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY; 3Department of Medicine, Columbia University Irving Medical Center, New York, NY
Background: The US Food and Drug Administration (FDA) recently issued a safety communication for reports of various lymphomas of the breast that developed in association with breast implants and were distinct from BIA-ALCL. We investigate the risk of non-BIA-ALCL breast lymphomas in a population of women who have undergone implant reconstruction after mastectomy for breast cancer.
Methods: We identified women who underwent mastectomy with implant-based reconstruction for tumors within the breast using the SEER 17 database (2000-2020). Multiple primary-standardized incidence ratios (SIR) were used to compare the number of observed versus expected cases of ALCL and non-ALCL breast lymphomas diagnosed in the study population.
Results: The final cohort comprised 61,043 women who were followed for 478,864 person-years. There were 7 observed cases of breast ALCL (SIR 43.7, 95% CI 17.6-90.1), 8 cases of other non-Hodgkin lymphomas (NHLs) of the breast (SIR 2.94, 95% CI 1.27-5.80), and 0 cases of Hodgkin lymphoma of the breast (SIR 0.00, 95% CI 0.00-168.6). Of the 8 cases of other breast lymphomas, 5 were diffuse large B-cell, 2 were small lymphocytic, and 1 was peripheral T-cell, not otherwise specified. In comparison, the risk of developing lymphomas outside of the breast was not elevated (SIR 0.98, 95% CI 0.86-1.11). Similarly, there was not an increased risk of NHLs in a control group of women who received mastectomy without implant-based reconstruction (SIR 1.30, 95% CI 0.90-1.80).
Conclusion: We report a novel epidemiological association of breast implants with both B- and T-cell NHL beyond BIA-ALCL. The risk of NHLs of the breast is significantly elevated following implant-based breast reconstruction. However, the absolute risk is extremely low and similar for ALCL and the identified NHL histologies. These findings may inform future guidance from regulatory agencies.
Relative and absolute risk of lymphomas of the breast after implant-based breast reconstruction. (incidence and excess risk in 1,000,000 persons/year)
| Histology | Cases Observed | Observed Incidence | Expected Incidence | Excess Risk | SIR (95% CI) |
| ALCL, breast | 7 | 14.6 | 0.4 | 14.3 | 41.6 (16.7-85.8) |
| Other lymphomas, breast | 8 | 16.7 | 5.9 | 10.8 | 2.84 (1.23-5.60) |
| Lymphomas, non-breast | 247 | 516 | 541 | -24.9 | 0.96 (0.84-1.08) |
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