title: Breast Implant-Associated Anaplastic Large Cell Lymphoma: Proposal for a Monitoring Protocol.
abstract: BACKGROUND
  The authors report four cases of breast implant-associated anaplastic large cell lymphoma (ALCL) from a single institution and propose a multidisciplinary protocol.
  
  
  METHODS
  From 2012 to 2014, four breast implant-associated ALCL cases were diagnosed. The authors performed the original operation, and no patients were referred to their practice. Cases 1, 2, and 4 were CD4/CD30/ALK ALCL with previous textured-implant reconstruction, whereas case 3 was CD8/CD30/ALK ALCL with previous polyurethane-implant augmentation. A retrospective study of all patients who underwent breast implant positioning was performed to identify any misdiagnosed cases.
  
  
  RESULTS
  Of 483 patients, 226 underwent reconstruction with latissimus dorsi flap and prosthesis, 115 had skin-sparing/nipple-sparing mastectomy and prosthesis, 117 underwent an expander/implant procedure, and 25 underwent breast augmentation. Fifty-eight cases (12 percent) underwent implant replacement for capsular contracture, 15 (3.1 percent) experienced late-onset seroma, and four (0.83 percent) had both capsular contracture and seroma. Seventy-seven symptomatic patients (16 percent) underwent surgical revision (capsulectomy/capsulotomy) and/or seroma evacuation. The second look on histologic specimens did not identify misdiagnosed cases. A multidisciplinary protocol for suspected implant-associated ALCL was established. Ultrasound and cytologic examinations are performed in case of periprosthetic effusion. If implant-associated ALCL is diagnosed, implant removal with capsulectomy is performed. If disseminated disease is detected through positron emission tomography/computed tomography of the total body, the patient is referred to the oncology department.
  
  
  CONCLUSIONS
  A multidisciplinary protocol is mandatory for both early diagnosis and patient management. Until definitive data emerge regarding the exact etiopathogenesis of breast implant-associated ALCL, the authors suggest offering only autologous reconstruction if patients desire it.
  
  
  METHODS
  Therapeutic, V.
authors.affiliation: Rome, Italy From the Plastic Surgery Unit, the Pathology Unit, Department of Clinical and Molecular Medicine, and the Hematology Department, Sant'Andrea Hospital, School of Medicine and Psychology, "Sapienza" University of Rome; and the Plastic Surgery Department, OORR Hospital, University of Foggia, loaned employee at the Italian Ministry of Health, Pharmaceutical Services, and Safety in Health Care.
authors.forename: Fabio
authors.initials: F
authors.lastname: Santanelli di Pompeo
authors.forename: Rosaria
authors.initials: R
authors.lastname: Laporta
authors.forename: Michail
authors.initials: M
authors.lastname: Sorotos
authors.forename: Arianna
authors.initials: A
authors.lastname: Di Napoli
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Giovagnoli
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Cox
authors.forename: Antonella
authors.initials: A
authors.lastname: Campanale
authors.forename: Benedetto
authors.initials: B
authors.lastname: Longo
mesh_terms: D000328:Adult; D017677:Age Distribution; D019928:Breast Implantation / Q000009:adverse effects* / Q000379:methods; D018427:Breast Implants / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D017728:Lymphoma, Large-Cell, Anaplastic / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D008408:Mastectomy / Q000379:methods*; D015412:Mastectomy, Segmental / Q000379:methods; D015414:Mastectomy, Subcutaneous / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000592:standards*; D020380:Needs Assessment; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D016019:Survival Analysis