Low Risk of ALCL With Postmastectomy Implant Reconstruction

Patricia McKnight

December 14, 2022

While there has been growing awareness of the risk of developing anaplastic large-cell lymphoma (ALCL) following cosmetic breast implant surgery, to date, there has been no study specifically concerning the risk of this complication among women who undergo implant reconstruction after a mastectomy.

A new study, which the authors believe provides the first population-based estimate of the risk of ALCL after implant-based reconstruction, has found that there is an increased risk of developing ACLC, which the authors say is similar to that reported with cosmetic or reconstructive implants.

They estimate that about 12 cases of ALCL are expected to occur yearly per 1 million women who undergo breast reconstruction surgery.

The authors emphasize that the "absolute risk remains extremely low" and that women should not be dissuaded from pursuing implant reconstruction after a mastectomy.

"For women who have a cancer diagnosis, hearing that there's a possibility of getting a second cancer can be very scary, and it's hard to put numbers into context for patients, especially when we don't know the incidence of the malignancy," said the study's lead author, Connor Kinslow, MD, radiation oncology resident at Columbia University.

"I felt like this study was important to just tell women that the risk of ALCL is very, very low and hopefully it's one less thing that they might need to worry about," he added.

The study was published on November 22 in JAMA Network Open.

Using the Surveillance, Epidemiology, and End Results (SEER) 17 database, researchers identified 56,784 women who underwent cancer-directed mastectomy with implant reconstruction from 2000 to 2018. The median age range of the patients was 45–50 years; 18% had in situ disease, and 72% had invasive disease. The median follow-up period was 84 months; for 15,765 women, follow-up was of at least 10 years.

The observed vs expected incidence rates were 11.9 vs 0.3 per million persons per year (excess risk, 11.6 cases/million/y; standardized incidence ratio [SIR] = 40.9; 95% CI, 13.3 – 95.5). One case of T-cell lymphoma not otherwise specified (T-NOS) was diagnosed, with similar excess risk (13.8 cases/million/y; SIR, 34.8; 95% CI, 12.8 – 75.8).

Limitations of the study included the fact that the risk of ALCL by type of implant (silicone vs saline; textured vs smooth) was not assessed. The authors also note that the latency time to develop ALCL after implantation may be long, so their study may underestimate the true incidence. Additionally, they did not account for implant removal or exchanges.

The authors recommend that patients with breast cancer who are eligible for mastectomy be counseled on the risks of ALCL after implant reconstruction.

"When women are making decisions regarding surgery and the potential for reconstruction and types of reconstruction that might be possible, I think that the breast surgeon doing the cancer surgery as well as the plastic surgeons have to play a major role in that," said senior author David Horowitz, MD, assistant professor of radiation oncology at Columbia University.

He added: "I think that in general, women are well served by having multidisciplinary management from the beginning, [starting at] the time of their diagnosis, so it's not just a single person who's having that discussion with them,"

JAMA Netw Open. Published online November 22, 2022. Full text

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