Breast implant-associated anaplastic large cell lymphoma in Romania: First case series of all documented cases

Abstract

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), an uncommon malignancy, was linked to textured breast implants by moderate evidence in 2021. Documenting Romanian cases provides valuable insights into the epidemiology, management, and outcomes, thereby, enhancing global understanding and informing clinical practices. Our objective was to analyze BIA-ALCL cases in Romania, focusing on patient demographics, implant characteristics, clinical presentation, diagnostic methods, treatment, and outcomes.

We conducted a retrospective review of all known BIA-ALCL cases in Romania by examining patient demographics, implant details, clinical presentation, diagnostic methods, and outcomes. Data sources included medical records, surgical reports, follow-up data, and implant characteristics such as shape, texture, and manufacturer of implants.

The mean age at diagnosis was 44.4 years. All 5 patients had textured implants and no replacements, 4 for aesthetic indication and 1 for reconstruction. The mean time from implantation to diagnosis was 7.2 years. Clinical presentations were primarily late seromas, diagnosed through fine needle aspiration and immunohistochemistry. Treatment involved multidisciplinary teams, with bilateral en-bloc explantation for all patients, and adjuvant therapies in 2 cases. One patient had immediate reconstruction with smooth implants and acellular dermal matrix. Notably, no disease recurrence was observed post-treatment.

The low BIA-ALCL prevalence in Romania estimated at 1:44,500 compared to the mean of 1:13,745 in Europe indicates the need for increased awareness and tracking. Establishing mandatory national implant registries, pathology databases, and enhancing physician and patient education will help identify potential cases. All cases involved textured implants, highlighting the need for ongoing research to identify risk factors and guide surgeons consulting patients with textured implants.