Where the path may lead: Chasing BIA-ALCL

Plastic Surgeons must frequently make difficult decisions, and the most challenging are under pressure with limited data and no clear path to follow.  Little to no information was first known about breast implant associated anaplastic large cell lymphoma (BIA-ALCL) when first introduced to physicians and the general public eight years ago.  This lack of information, particularly about an iatrogenic malignancy, created anxiety in the public and the media.  To meet the challenge of BIA-ALCL, our specialty rapidly raised disease awareness, established patient registries, and prioritized research on lymphoma development.  This thematic issue highlights some of the most important articles that advanced our understanding of BIA-ALCL. 

The following pages focus on international guidelines for diagnosis and treatment, perception of risk, informed consent, lines of pathogenesis, critical case reports, and long-term outcomes data on textured breast implants – all essential reading for plastic surgeons.  Collectively these articles illuminate our path, help us find a better understanding of BIA-ALCL like never before, so that we might better meet this surgical challenge for the health and safety of our patients.

Mark W. Clemens, MD, FACS
Associate Professor, Plastic Surgery
MD Anderson Cancer Center
University of Texas
Houston, TX
@clemensmd

What's Your Micromort? A Patient-Oriented Analysis of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)
David A Sieber, MD and William P Adams, Jr, MD

The Micromort Concept and its Applicability to Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) Risk Assessment
Richard A Baxter, MD

Why the Micromort Concept Falls Short in Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) Risk Analysis
Eric Swanson, MD and Donald R Mackay, MD

Response to “Why the Micromort Concept Falls Short in Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) Risk Analysis”
David A Sieber, MD and William P Adams, Jr, MD

Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): Why the Search for an Infectious Etiology May Be Irrelevant
Eric Swanson, MD

Response to “Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): Why the Search for an Infectious Etiology May Be Irrelevant”
Anand K Deva, BSc (Med), MBBS, MS, FRACS (Plast)

Biomarkers Provide Clues to Early Events in the Pathogenesis of Breast Implant-Associated Anaplastic Large Cell Lymphoma
Marshall E. Kadin, MD, Anand Deva, MD, Haiying Xu, BS, John Morgan, PhD, et al.

Commentary on: Biomarkers Provide Clues to Early Events in the Pathogenesis of Breast Implant-Associated Anaplastic Large Cell Lymphoma 
H. Miles Prince, MD and Ricky Johnstone, PhD

NCCN Consensus Guidelines for the Diagnosis and Management of Breast Implant-Associated Anaplastic Large Cell Lymphoma 
Mark W. Clemens, MD and Steven M. Horwitz, MD  

CD30+ T Cells in Late Seroma May Not Be Diagnostic of Breast Implant-Associated Anaplastic Large Cell Lymphoma 
Marshall E Kadin, MD, John Morgan, PhD, Haiying Xu, BS, and Caroline A Glicksman, MD

Commentary on: CD30+ T Cells in Late Seroma May Not Be Diagnostic of Breast Implant-Associated Anaplastic Large Cell Lymphoma
Mark W Clemens, MD, FACS and Roberto N Miranda, MD

Commentary on: CD30+ T Cells in Late Seroma May Not Be Diagnostic of Breast Implant-Associated Anaplastic Large Cell Lymphoma 
Anand K Deva, BSc (Med), MBBS, MS, FRACS (Plast)

Long-Term Safety of Textured and Smooth Breast Implants
M. Bradley Calobrace, MD, Michael R Schwartz, MD, and Kamakshi R Zeidler, MD

Response to “Comments on 'Long-Term Safety of Textured and Smooth Breast Implants' and a Plea to Abandon the Use of the MAUDE Database”
M Bradley Calobrace, MD, FACS, Michael R Schwartz, MD, Kamakshi R Zeidler, MD, et al.

Breast Implant-Associated Anaplastic Large-Cell Lymphoma in a Transgender Woman
Mintsje de Boer, MD, Wouter B van der Sluis, MD, PhD, Jan P de Boer, MD, PhD, et al. 

Breast Erythema in a Patient With Breast Implant-Associated Anaplastic Large Cell Lymphoma: A Case Report Discussing Cutaneous Manifestations
Sarah M Elswick, MD and Minh-Doan T Nguyen, MD, PhD

Commentary on: Breast Erythema in a Patient With Breast Implant-Associated Anaplastic Large Cell Lymphoma: A Case Report Discussing Cutaneous Manifestations
Anand K Deva, BSc (Med), MBBS, MS, FRACS (Plast)

Novel Proteomic Assay of Breast Implants Reveals Proteins With Significant Binding Differences: Implications for Surface Coating and Biocompatibility
Simon Patrick Barr, MBChB, Ernie W Hill, PhD and Ardeshir Bayat, PhD, MBBS

Commentary on: Novel Proteomic Assay of Breast Implants Reveals Proteins with Significant Binding Differences: Implications for Surface Coating and Biocompatibility
Mark W Clemens, MD, FACS

Breast Implant-Associated Anaplastic Large Cell Lymphoma With Bone Marrow Involvement
Sanam Loghavi, MD, L. Jeffrey Medeiros, MD, Sanaz Javadi, MD, et al.