BIA-ALCL Epidemiological Findings From a Retrospective Study of 248 Cases Extracted from Relevant Case Reports and Series: A Systematic Review.

BACKGROUND: The epidemiologic picture of Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL) is unclear, with no high-level evidence, as only case reports and series are available.

OBJECTIVES: We aimed at updating the BIA-ALCL epidemiology by using all available data through a systematic review of scientific literature.

METHODS: A search on PubMed, Scopus, and Web of Science was conducted between October 2021 and April 2022. Out of the 2,799 available records, we selected 114 pertinent articles, featuring 248 BIA-ALCL cases which were retrospectively analyzed by means of descriptive statistics, incidence rate (IR), Kaplan-Meier survival curves and Pearson correlation coefficient.

RESULTS: United States, Netherlands, Italy, and Australia were the most reporting countries. Mean age at 1st implantation was 42y, and 53y at diagnosis. Aesthetic indication was 52% and reconstructive 48%, macrotextured surface was linked to 73.8% of cases and seroma to 83%. Total follow-up was 492 months, mean Event Free Time (EFT) to BIA-ALCL development was 129 months. IR was 96 new cases/1.000 women per year after first implantation, and directly correlated to number of replacements. EFT was directly correlated to number of replacements, implant rupture and capsule contracture, while inversely associated to patients' age at first implantation and to BRACA1/2 and TP53 mutations.

CONCLUSIONS: Macrotextured implants use in older patients and in BRCA1/2 and TP53 mutated should be reconsidered, being associated to earlier disease onset. Implant replacement of asymptomatic, risk-stratified patients, can be indicated due to its protective role against BIA-ALCL, reducing IR rate and risk, while increasing the EFT.