Risk of Anaplastic Large-Cell Lymphoma (ALCL) in Cases of Late Seroma Formation After Breast Implant Insertion

Kun Hwang, MD, PhD; Hun Kim, PhD; Hyung Mook Kim, MD; Joo Ho Kim, MD


ePlasty. 2021;21:e4 

In This Article

Abstract and Introduction


Purpose: The aim of this study was to determine the odds ratio of anaplastic large-cell lymphoma in late seroma formation.

Methods: In a PubMed search, 415 articles were found using the terms "breast implant AND seroma" (n = 232), "breast implant AND effusion" (n = 42), and "anaplastic large cell lymphoma AND breast (n = 141). Sixty-seven abstracts were read, and 27 full articles were reviewed.

Results: Three articles reported the incidence of late seroma in breast implants, with a total of 75 seromas out of 48,211 implants (0.16%). One article reported 48 cases of non-Hodgkin lymphoma from 43,537 implants (0.11%). Another article reported that 11 patients had anaplastic large-cell lymphoma among 389 primary lymphoma of the breast (2.83%). Two articles reported 143 seromas out of 236 anaplastic large-cell lymphomas (60.59%). The risk of anaplastic large-cell lymphoma was significantly higher in the patients having late seroma than those without seroma (odds ratio = 998.93; 95% confidence interval, 768.90–1297.78; P < .001). The incidence of anaplastic large-cell lymphoma in seroma was calculated by dividing the number of anaplastic large cell lymphomas with seroma (n = 143) by total seroma (N = 11,843), which resulted in an incidence of 1.21%. The expected incidence of anaplastic large-cell lymphoma in seroma was 1.21%.

Conclusion: If late seroma develops after breast implant insertion, ultrasonography-guided aspiration should be performed, with enzyme-linked-immunosorbent serologic assay for CD30.


Breast implant–associated anaplastic large-cell lymphoma (ALCL) has recently come to the attention of researchers and clinicians. It most frequently presents as an effusion-associated fibrous capsule surrounding an implant but can present as a mass in some cases.[1] According to the American Cancer Society, approximately 2% of lymphomas can be classified as ALCL.[2] Recently, several review articles about ALCL have been published, but very few studies have focused on the association of ALCL with late seroma.[1,3,4]

The aim of this study was to determine the odds ratio (OR) of late seroma formation for ALCL.