{"title":"Case report of stacked intercostal artery perforator flaps: a novel technique using anterior and lateral intercostal artery perforator flaps for full autologous breast reconstruction post-mastectomy","authors":"Hui Jun Lim, C. Mok, S. Tan","doi":"10.21037/abs-21-79","DOIUrl":"https://doi.org/10.21037/abs-21-79","url":null,"abstract":"","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48450057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sentinel lymph node biopsy using dual radioisotope and Patent Blue dye remains the gold standard in intraoperative assessment of the axilla in early breast cancer (1). However, difficulties exist in both the worldwide supply of Technetium (2) and its use in hospitals without an ARSAC license. With recent changes in delivery of breast cancer services, secondary to pressures from COVID-19, Original Article
{"title":"A single centre experience in the use of superparamagnetic iron oxide as an alternative tracer in sentinel node biopsy in early breast cancer","authors":"Norah Scally, L. Armstrong, H. Mathers","doi":"10.21037/ABS-21-24","DOIUrl":"https://doi.org/10.21037/ABS-21-24","url":null,"abstract":"Sentinel lymph node biopsy using dual radioisotope and Patent Blue dye remains the gold standard in intraoperative assessment of the axilla in early breast cancer (1). However, difficulties exist in both the worldwide supply of Technetium (2) and its use in hospitals without an ARSAC license. With recent changes in delivery of breast cancer services, secondary to pressures from COVID-19, Original Article","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41877898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Hentz, G. Harmon, T. Refaat, T. Thomas, W. Small
: Over the past several decades, radiation therapy has played a key role in the management of breast cancer. Although the oncologic benefits of radiotherapy are well established, the landscape of breast oncology is ever changing and evolving, and radiation is no exception. Radiation oncologists are pursuing new technology and techniques to maintain their oncologic benefits, while minimizing potential side effects and treatment burden. This has led to clinical trials using therapy de-escalation of radiation in select patients with favorable characteristics. Multiple studies are using modern genetic testing, such as Oncotype Dx and PAM50, to identify low-risk women that may potentially have radiation omitted in favor of endocrine therapy alone. Another area of active investigation is the de-escalation of therapy in node-positive patients, using genetic testing or response to neoadjuvant systemic therapy as prognostic factors. The use of hypofractionation has become standard of care in the breast conservation setting, but its use in the post-mastectomy is an area of interest in multiple ongoing studies. Partial breast irradiation (PBI) is another evolving avenue to shorten treatment time, with multiple modalities available. Other investigators are attempting to alter the traditional treatment paradigm of breast cancer by administrating radiation in the preoperative setting rather than postoperative. New technologies such as proton therapy and stereotactic body radiation therapy (SBRT) have made their way into ongoing trials as well. In the setting of oligometastatic breast cancer, several trials are attempting to use SBRT as metastasis directed therapy to improve oncologic outcomes. In this review, we cover several ongoing important breast radiation clinical trials and how they will impact breast cancer care.
{"title":"Future directions of radiation therapy in the management of breast cancer","authors":"C. Hentz, G. Harmon, T. Refaat, T. Thomas, W. Small","doi":"10.21037/ABS-20-132","DOIUrl":"https://doi.org/10.21037/ABS-20-132","url":null,"abstract":": Over the past several decades, radiation therapy has played a key role in the management of breast cancer. Although the oncologic benefits of radiotherapy are well established, the landscape of breast oncology is ever changing and evolving, and radiation is no exception. Radiation oncologists are pursuing new technology and techniques to maintain their oncologic benefits, while minimizing potential side effects and treatment burden. This has led to clinical trials using therapy de-escalation of radiation in select patients with favorable characteristics. Multiple studies are using modern genetic testing, such as Oncotype Dx and PAM50, to identify low-risk women that may potentially have radiation omitted in favor of endocrine therapy alone. Another area of active investigation is the de-escalation of therapy in node-positive patients, using genetic testing or response to neoadjuvant systemic therapy as prognostic factors. The use of hypofractionation has become standard of care in the breast conservation setting, but its use in the post-mastectomy is an area of interest in multiple ongoing studies. Partial breast irradiation (PBI) is another evolving avenue to shorten treatment time, with multiple modalities available. Other investigators are attempting to alter the traditional treatment paradigm of breast cancer by administrating radiation in the preoperative setting rather than postoperative. New technologies such as proton therapy and stereotactic body radiation therapy (SBRT) have made their way into ongoing trials as well. In the setting of oligometastatic breast cancer, several trials are attempting to use SBRT as metastasis directed therapy to improve oncologic outcomes. In this review, we cover several ongoing important breast radiation clinical trials and how they will impact breast cancer care.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43157139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Response to “Work-up and management of breast pain”","authors":"T. Adeboye, Eniola Olayato-Aribo","doi":"10.21037/abs-21-138","DOIUrl":"https://doi.org/10.21037/abs-21-138","url":null,"abstract":"","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46814196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Dissing, Emma Edvardsen, Juliane Schierbeck, J. Thomsen, S. Cold, C. Bille
Department of Plastic Surgery, Odense University Hospital, J.B. Winsløwsvej, Odense, Denmark; Department of Medical Oncology, Odense University Hospital, J.B. Winsløwsvej, Odense, Denmark Contributions: (I) Conception and design: All authors; (II) Administrative support: All authors; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: E Evardsen; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. These authors contributed equally to this work. Correspondence to: Josephine Dissing. Department of Plastic Surgery, Odense University Hospital, J.B. Winsløwsvej, Odense, Denmark. Email: Jdissing_651@hotmail.com.
{"title":"Surgical complications after immediate breast reconstruction vs. mastectomy alone: impact on the time to delivery of adjuvant therapy","authors":"J. Dissing, Emma Edvardsen, Juliane Schierbeck, J. Thomsen, S. Cold, C. Bille","doi":"10.21037/abs-21-113","DOIUrl":"https://doi.org/10.21037/abs-21-113","url":null,"abstract":"Department of Plastic Surgery, Odense University Hospital, J.B. Winsløwsvej, Odense, Denmark; Department of Medical Oncology, Odense University Hospital, J.B. Winsløwsvej, Odense, Denmark Contributions: (I) Conception and design: All authors; (II) Administrative support: All authors; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: E Evardsen; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. These authors contributed equally to this work. Correspondence to: Josephine Dissing. Department of Plastic Surgery, Odense University Hospital, J.B. Winsløwsvej, Odense, Denmark. Email: Jdissing_651@hotmail.com.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48530115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The role of the geriatrician in the care of older patients with breast cancer: a review","authors":"S. Festen, P. de Graeff, S. Rostoft","doi":"10.21037/abs-21-119","DOIUrl":"https://doi.org/10.21037/abs-21-119","url":null,"abstract":"","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45657341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mette Eline Brunbjerg, T. Jensen, J. Overgaard, P. Christiansen, T. Damsgaard
Background: The introduction of acellular dermal matrices revolutionized implant-based breast reconstructive procedures. Literature reports both advantages and disadvantages associated to the use of acellular dermal matrix (ADM). The increasing number of breast reconstructive procedures being performed leads to an awareness of improving the psychosocial and functional result and reduce costs associated with these procedures. One-stage implant-based breast reconstruction (BR) with ADM has potential advantages for the patient, but literature shows conflicting results regarding the cost-effectiveness of this approach compared to the two-stage expander-to-implant method. The patient’s subjective assessment of the physical and psychosocial effects of BR is extremely important. To contribute to knowledge on the subject, we present a study where the aim was to compare immediate implant-based BR using the ADM assisted one-stage approach with the two-stage expander-to-implant approach regarding resource utilization and patient reported outcomes (PROs). Methods: The study was designed as an observational cohort study with 44 participants admitted for immediate implant-based BR at Department of Plastic Surgery, Aarhus University Hospital, Aarhus, Denmark. BR was performed with a one-stage technique in 21 patients and with a two-stage technique in 23 patients. Follow-up time was 2 years. Results: Overall, in favor of the one-stage group was a shorter duration of surgery and furthermore, the reduced need for outpatient visits (for expansions) as well as for additional surgery for implant exchange. In favor of the two-stage approach was reduced cost of materials and fewer interventions to address the aesthetic outcome. Pain, sensory disturbances, physical limitations, health status, quality of life (QoL) and body image were equally favorable between the two groups at 2-year follow-up. Conclusions: This study does not provide clear evidence for an advantageous use of resources by one method versus the other and further studies should be undertaken to investigate the cost-effectiveness. Considering the equally good results in the two treatment groups regarding PROs the one-stage approach may be preferred if the patient is deemed suitable and is well informed of the potential need for additional interventions to obtain an aesthetically satisfying result.
{"title":"Resource utilization and patient reported outcomes using acellular dermal matrix in breast reconstructive procedures","authors":"Mette Eline Brunbjerg, T. Jensen, J. Overgaard, P. Christiansen, T. Damsgaard","doi":"10.21037/abs-21-81","DOIUrl":"https://doi.org/10.21037/abs-21-81","url":null,"abstract":"Background: The introduction of acellular dermal matrices revolutionized implant-based breast reconstructive procedures. Literature reports both advantages and disadvantages associated to the use of acellular dermal matrix (ADM). The increasing number of breast reconstructive procedures being performed leads to an awareness of improving the psychosocial and functional result and reduce costs associated with these procedures. One-stage implant-based breast reconstruction (BR) with ADM has potential advantages for the patient, but literature shows conflicting results regarding the cost-effectiveness of this approach compared to the two-stage expander-to-implant method. The patient’s subjective assessment of the physical and psychosocial effects of BR is extremely important. To contribute to knowledge on the subject, we present a study where the aim was to compare immediate implant-based BR using the ADM assisted one-stage approach with the two-stage expander-to-implant approach regarding resource utilization and patient reported outcomes (PROs). Methods: The study was designed as an observational cohort study with 44 participants admitted for immediate implant-based BR at Department of Plastic Surgery, Aarhus University Hospital, Aarhus, Denmark. BR was performed with a one-stage technique in 21 patients and with a two-stage technique in 23 patients. Follow-up time was 2 years. Results: Overall, in favor of the one-stage group was a shorter duration of surgery and furthermore, the reduced need for outpatient visits (for expansions) as well as for additional surgery for implant exchange. In favor of the two-stage approach was reduced cost of materials and fewer interventions to address the aesthetic outcome. Pain, sensory disturbances, physical limitations, health status, quality of life (QoL) and body image were equally favorable between the two groups at 2-year follow-up. Conclusions: This study does not provide clear evidence for an advantageous use of resources by one method versus the other and further studies should be undertaken to investigate the cost-effectiveness. Considering the equally good results in the two treatment groups regarding PROs the one-stage approach may be preferred if the patient is deemed suitable and is well informed of the potential need for additional interventions to obtain an aesthetically satisfying result.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47441433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: Papillary lesions of the breast are classified as benign or malignant. Making a definitive diagnosis for a papillary lesion based on a core needle biopsy remains a challenge for pathologists. Intraductal papillomas are a common benign lesion of the breast with variable presentations. They may be identified with or without atypia and may present with or without symptoms, often identified on breast imaging. Patients with intraductal papillomas with atypia should be referred for surgical excision due to the higher rate of upstaging to malignancy and they should also be referred for high risk assessment for possible chemoprevention. Unlike intraductal papillomas with atypia, there is no consensus for the management of intraductal papillomas without atypia and the management of intraductal papillomas without atypia has been controversial. Retrospective studies for intraductal papillomas without atypia have shown upstaging rates to carcinoma ranging from 0–33%. Excision can be considered for those patients presenting with symptoms such as palpable masses, nipple discharge or larger masses greater than 1 cm. Surgical excision is not indicated for asymptomatic intraductal papillomas without atypia where there is pathologic-radiographic concordance based on the prospective TBCRC 034 trial. The objective of this article is to review the current literature with series published over the last 5 years regarding intraductal papillomas with and without atypia and to summarize their management.
{"title":"Intraductal papillomas of the breast","authors":"K. Calvillo, Leah H. Portnow","doi":"10.21037/abs-20-113","DOIUrl":"https://doi.org/10.21037/abs-20-113","url":null,"abstract":": Papillary lesions of the breast are classified as benign or malignant. Making a definitive diagnosis for a papillary lesion based on a core needle biopsy remains a challenge for pathologists. Intraductal papillomas are a common benign lesion of the breast with variable presentations. They may be identified with or without atypia and may present with or without symptoms, often identified on breast imaging. Patients with intraductal papillomas with atypia should be referred for surgical excision due to the higher rate of upstaging to malignancy and they should also be referred for high risk assessment for possible chemoprevention. Unlike intraductal papillomas with atypia, there is no consensus for the management of intraductal papillomas without atypia and the management of intraductal papillomas without atypia has been controversial. Retrospective studies for intraductal papillomas without atypia have shown upstaging rates to carcinoma ranging from 0–33%. Excision can be considered for those patients presenting with symptoms such as palpable masses, nipple discharge or larger masses greater than 1 cm. Surgical excision is not indicated for asymptomatic intraductal papillomas without atypia where there is pathologic-radiographic concordance based on the prospective TBCRC 034 trial. The objective of this article is to review the current literature with series published over the last 5 years regarding intraductal papillomas with and without atypia and to summarize their management.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49354435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: In the last decade, more women are undergoing post-mastectomy reconstruction. The purpose of this study is to examine the evolving changes in mastectomy techniques and post-mastectomy reconstruction for breast cancer patients. Methods: Patients in the Surveillance, Epidemiology, and End Results (SEER) database were included from 2004 to 2014 based on a diagnosis of breast cancer using the ICD O-3 primary site codes: C50.0–50.6 and C50.8–50.9 who underwent a nipple sparing, total simple, modified radical, or radical mastectomy. Patients were categorized into 2- or 3-year cohorts based on their year of diagnosis. Results: A total of 263,161 breast cancer cases were identified. Patients tended to be middle-aged females (mean age: 59.6 years old). 35.0% of patients received a total simple mastectomy in the 2004–2005 cohort compared to 61.8% of patients in the 2012–2014 cohort (P<0.001). Regarding reconstruction technique, 14.7% of patients received post-mastectomy breast reconstruction in the 2004–2005 cohort while 31.7% received post-mastectomy breast reconstruction in the 2012–2014 cohort (P<0.001). Conclusions: Breast cancer patients who undergo mastectomies are likely to be middle-aged Caucasian females. An increased percentage of patients who receive mastectomies have lower stage disease. A higher number of patients are receiving total simple mastectomies over time as compared to modified radical mastectomies. Patients who receive a total simple mastectomy have a higher chance of receiving breast reconstruction. Finally, the use of breast implant reconstruction has increased compared to tissue reconstruction for mastectomy patients.
{"title":"Recent trends in total mastectomy techniques and post-mastectomy breast cancer reconstruction: a population-based analysis","authors":"Kaye Lu, Karen B. Lu, Tyler A. Janz, B. Amirlak","doi":"10.21037/abs-21-146","DOIUrl":"https://doi.org/10.21037/abs-21-146","url":null,"abstract":"Background: In the last decade, more women are undergoing post-mastectomy reconstruction. The purpose of this study is to examine the evolving changes in mastectomy techniques and post-mastectomy reconstruction for breast cancer patients. Methods: Patients in the Surveillance, Epidemiology, and End Results (SEER) database were included from 2004 to 2014 based on a diagnosis of breast cancer using the ICD O-3 primary site codes: C50.0–50.6 and C50.8–50.9 who underwent a nipple sparing, total simple, modified radical, or radical mastectomy. Patients were categorized into 2- or 3-year cohorts based on their year of diagnosis. Results: A total of 263,161 breast cancer cases were identified. Patients tended to be middle-aged females (mean age: 59.6 years old). 35.0% of patients received a total simple mastectomy in the 2004–2005 cohort compared to 61.8% of patients in the 2012–2014 cohort (P<0.001). Regarding reconstruction technique, 14.7% of patients received post-mastectomy breast reconstruction in the 2004–2005 cohort while 31.7% received post-mastectomy breast reconstruction in the 2012–2014 cohort (P<0.001). Conclusions: Breast cancer patients who undergo mastectomies are likely to be middle-aged Caucasian females. An increased percentage of patients who receive mastectomies have lower stage disease. A higher number of patients are receiving total simple mastectomies over time as compared to modified radical mastectomies. Patients who receive a total simple mastectomy have a higher chance of receiving breast reconstruction. Finally, the use of breast implant reconstruction has increased compared to tissue reconstruction for mastectomy patients.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42626924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Lynch, Ryan C DeCoster, Krishna S. Vyas, B. Rinker, Mei Yang, H. Vásconez, M. Clemens
Recent epidemiological studies have attempted to accurately determine the risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). However, comparisons of previously published works are difficult due to widespread variations in reporting. We systematically review the epidemiology in order to better define the current risk of BIA-ALCL. Herein, we report the global epidemiology with an emphasis on the U.S. breast implant population while simultaneously assessing the oncologic safety of smooth-surface devices. In the current manuscript, a systematic review of PubMed and other scientific databases, as well as the grey literature, was conducted for epidemiologic studies on BIA-ALCL. Using analytical and descriptive epidemiology, we estimated the cumulative incidence and incidence rate of BIA-ALCL using a standardized approach. Cumulative incidence was reported at implant and patient-specific levels. The patient-specific cumulative risk within the U.S. market ranges from 1.79 per 1,000 (1:559) to 2.82 per 1,000 (1:355) patients with a textured implant. The implant-specific risk of Allergan textured devices ranges from 1:602–871 to 1:8,500, while the risk of commercially available Mentor Siltex implants is 1:50,000. No epidemiological study or regulatory agency reported a case of BIA-ALCL occurring exclusively with a smooth device. As such, with the removal of Allergan textured breast devices, this study demonstrates substantial gaps in the epidemiological knowledge of BIA-ALCL, including the current risk of commercially available textured breast implants in the U.S. market. Although the risk of BIA-ALCL is low, surgeons should exercise extreme caution when considering the use of a textured breast device for cosmetic or reconstructive purposes.
{"title":"Current risk of breast implant-associated anaplastic large cell lymphoma: a systematic review of epidemiological studies","authors":"E. Lynch, Ryan C DeCoster, Krishna S. Vyas, B. Rinker, Mei Yang, H. Vásconez, M. Clemens","doi":"10.21037/abs-20-96","DOIUrl":"https://doi.org/10.21037/abs-20-96","url":null,"abstract":"Recent epidemiological studies have attempted to accurately determine the risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). However, comparisons of previously published works are difficult due to widespread variations in reporting. We systematically review the epidemiology in order to better define the current risk of BIA-ALCL. Herein, we report the global epidemiology with an emphasis on the U.S. breast implant population while simultaneously assessing the oncologic safety of smooth-surface devices. In the current manuscript, a systematic review of PubMed and other scientific databases, as well as the grey literature, was conducted for epidemiologic studies on BIA-ALCL. Using analytical and descriptive epidemiology, we estimated the cumulative incidence and incidence rate of BIA-ALCL using a standardized approach. Cumulative incidence was reported at implant and patient-specific levels. The patient-specific cumulative risk within the U.S. market ranges from 1.79 per 1,000 (1:559) to 2.82 per 1,000 (1:355) patients with a textured implant. The implant-specific risk of Allergan textured devices ranges from 1:602–871 to 1:8,500, while the risk of commercially available Mentor Siltex implants is 1:50,000. No epidemiological study or regulatory agency reported a case of BIA-ALCL occurring exclusively with a smooth device. As such, with the removal of Allergan textured breast devices, this study demonstrates substantial gaps in the epidemiological knowledge of BIA-ALCL, including the current risk of commercially available textured breast implants in the U.S. market. Although the risk of BIA-ALCL is low, surgeons should exercise extreme caution when considering the use of a textured breast device for cosmetic or reconstructive purposes.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85614134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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