Apr 19, 2011
A Systematic Review
Published In: Plastic and Reconstructive Surgery, v. 127, no. 6, June 2011, p. 2141-2150
Posted on RAND.org on May 31, 2011
BACKGROUND: In recent years, there have been growing concerns about a possible association of non-Hodgkin's lymphoma (NHL)-in particular, anaplastic large cell lymphoma (ALCL)-and breast implants. The purpose of this study was to identify and analyze all reported cases of NHL occurring in patients with breast implants. METHODS: We conducted a systematic literature review of reported cases of NHL in patients with breast implants. Publications were identified with a search algorithm, forward searches, and expert nominations. After references were reviewed and assessed for inclusion or exclusion, case-based data were independently abstracted, reconciled, and adjudicated by multiple investigators. The data were then synthesized and analyzed. RESULTS: Of 884 identified articles, only 83 were relevant to NHL involving the breast and 34 were included in our study. Thirty-six cases of NHL in patients with implants were found, of which 29 (81%) were ALCLs. Although detailed clinical information was lacking in many cases, ALCL oftentimes involved the capsule and/or presented as an unexplained seroma or mass, was negative for Anaplastic Lymphoma Kinase (ALK) expression, and had a relatively indolent clinical course when it developed adjacent to a breast implant. CONCLUSIONS: A form of ALCL, which clinically behaves more like the less-aggressive cutaneous form of ALK-negative ALCL rather than the more-aggressive systemic form, may be associated with breast implants. Future research on the epidemiology and biology of this rare disease is clearly needed to better understand its nature.