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Implants and Cancer
Laurie Margolies, MD; Wendie A. Berg, MD, PhD
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KEY FACTS

  • Imaging

    • Pathology

      • Clinical Issues

        TERMINOLOGY

        • Definitions

          • Cosmetic breast implant: Implant placed for augmentation or asymmetry
          • Implant reconstruction: Implant placed after mastectomy, usually for cancer
          • Contracture: Tightening of fibrous capsule around implant
            • Baker grade I (soft, normal appearance) to grade IV (hard, painful, abnormal-looking breast; rounded implant)

        IMAGING

        • General Features

          • Mammographic Findings

            • Ultrasonographic Findings

              • CT Findings

                • MR Findings

                  • Imaging Recommendations

                    • Nuclear Medicine Findings

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • Staging, Grading, & Classification

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Campanale A et al: 22 Cases of breast implant-associated ALCL: awareness and outcome tracking from the Italian Ministry of Health. Plast Reconstr Surg. 141(1):11e-19e, 2018
                                      2. de Boer M et al: Breast implants and the risk of anaplastic large-cell lymphoma in the breast. JAMA Oncol. 4(3):335-341, 2018
                                      3. Expert Panel on Breast Imaging et al: ACR Appropriateness Criteria® breast implant evaluation. J Am Coll Radiol. 15(5S):S13-S25, 2018
                                      4. Fleming D et al: Spontaneous regression and resolution of breast implant-associated anaplastic large cell lymphoma: implications for research, diagnosis and clinical management. Aesthetic Plast Surg. 42(3):672-678, 2018
                                      5. Mehta-Shah N et al: How I treat breast implant-associated anaplastic large cell lymphoma. Blood. 132(18):1889-98, 2018
                                      6. Noroozian M et al: Use of screening mammography to detect occult malignancy in autologous breast reconstructions: a 15-year experience. Radiology. 172783, 2018
                                      7. Sosin M et al: Breast cancer following augmentation mammaplasty: a case-control study. Plast Reconstr Surg. 141(4):833-40, 2018
                                      8. Clemens MW et al: NCCN consensus guidelines for the diagnosis and management of breast implant-associated anaplastic large cell lymphoma. Aesthet Surg J. 37(3):285-9, 2017
                                      9. Johnson L et al: Breast implant associated anaplastic large cell lymphoma: the UK experience. Recommendations on its management and implications for informed consent. Eur J Surg Oncol. 43(8):1393-1401, 2017
                                      10. Leberfinger AN et al: Breast implant-associated anaplastic large cell lymphoma: a systematic review. JAMA Surg. 152(12):1161-8, 2017
                                      11. Mango VL et al: Breast carcinoma in augmented breasts: MRI findings. AJR Am J Roentgenol. 204(5):W599-604, 2015
                                      12. Noels EC et al: Breast implants and the risk of breast cancer: a meta-analysis of cohort studies. Aesthet Surg J. 35(1):55-62, 2015
                                      13. Albornoz CR et al: A paradigm shift in U.S. Breast reconstruction: increasing implant rates. Plast Reconstr Surg. 131(1):15-23, 2013
                                      14. Lavigne E et al: Breast cancer detection and survival among women with cosmetic breast implants: systematic review and meta-analysis of observational studies. BMJ. 346:f2399, 2013
                                      15. U.S. Food and Drug Administration: FDA medical device safety communication: reports of anaplastic large cell lymphoma (ALCL) in women with breast implants. http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm240000.htm. Accessed May 25, 2013
                                      16. Aladily TN et al: Breast implant-associated anaplastic large cell lymphoma: a newly recognized entity that needs further refinement of its definition. Leuk Lymphoma. 53(4):749-50, 2012
                                      17. Kronowitz SJ: Current status of implant-based breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg. 130(4):513e-523e, 2012
                                      18. Lavigne E et al: Do breast implants adversely affect prognosis among those subsequently diagnosed with breast cancer? Findings from an extended follow-up of a Canadian cohort. Cancer Epidemiol Biomarkers Prev. 21(10):1868-76, 2012
                                      19. Pan SY et al: Canadian breast implant cohort: extended follow-up of cancer incidence. Int J Cancer. 131(7):E1148-57, 2012
                                      20. Lipworth L et al: Cancer among Scandinavian women with cosmetic breast implants: a pooled long-term follow-up study. Int J Cancer. 124(2):490-3, 2009
                                      21. Handel N et al: Breast cancer diagnosis and prognosis in augmented women. Plast Reconstr Surg. 118(3):587-93; discussion 594-6, 2006
                                      22. Brown SL et al: Breast implant adverse events during mammography: reports to the Food and Drug Administration. J Womens Health (Larchmt). 13(4):371-8; discussion 379-80, 2004
                                      23. Miglioretti DL et al: Effect of breast augmentation on the accuracy of mammography and cancer characteristics. JAMA. 291(4):442-50, 2004
                                      24. Hoshaw SJ et al: Breast implants and cancer: causation, delayed detection, and survival. Plast Reconstr Surg. 107(6):1393-407, 2001
                                      25. Handel N et al: Factors affecting mammographic visualization of the breast after augmentation mammaplasty. JAMA. 268(14):1913-7, 1992
                                      26. Breast Implant-Associated Anaplastic Large Cell Lymphoma
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Imaging

                                        • Pathology

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Definitions

                                              • Cosmetic breast implant: Implant placed for augmentation or asymmetry
                                              • Implant reconstruction: Implant placed after mastectomy, usually for cancer
                                              • Contracture: Tightening of fibrous capsule around implant
                                                • Baker grade I (soft, normal appearance) to grade IV (hard, painful, abnormal-looking breast; rounded implant)

                                            IMAGING

                                            • General Features

                                              • Mammographic Findings

                                                • Ultrasonographic Findings

                                                  • CT Findings

                                                    • MR Findings

                                                      • Imaging Recommendations

                                                        • Nuclear Medicine Findings

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • Staging, Grading, & Classification

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Consider

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Campanale A et al: 22 Cases of breast implant-associated ALCL: awareness and outcome tracking from the Italian Ministry of Health. Plast Reconstr Surg. 141(1):11e-19e, 2018
                                                                          2. de Boer M et al: Breast implants and the risk of anaplastic large-cell lymphoma in the breast. JAMA Oncol. 4(3):335-341, 2018
                                                                          3. Expert Panel on Breast Imaging et al: ACR Appropriateness Criteria® breast implant evaluation. J Am Coll Radiol. 15(5S):S13-S25, 2018
                                                                          4. Fleming D et al: Spontaneous regression and resolution of breast implant-associated anaplastic large cell lymphoma: implications for research, diagnosis and clinical management. Aesthetic Plast Surg. 42(3):672-678, 2018
                                                                          5. Mehta-Shah N et al: How I treat breast implant-associated anaplastic large cell lymphoma. Blood. 132(18):1889-98, 2018
                                                                          6. Noroozian M et al: Use of screening mammography to detect occult malignancy in autologous breast reconstructions: a 15-year experience. Radiology. 172783, 2018
                                                                          7. Sosin M et al: Breast cancer following augmentation mammaplasty: a case-control study. Plast Reconstr Surg. 141(4):833-40, 2018
                                                                          8. Clemens MW et al: NCCN consensus guidelines for the diagnosis and management of breast implant-associated anaplastic large cell lymphoma. Aesthet Surg J. 37(3):285-9, 2017
                                                                          9. Johnson L et al: Breast implant associated anaplastic large cell lymphoma: the UK experience. Recommendations on its management and implications for informed consent. Eur J Surg Oncol. 43(8):1393-1401, 2017
                                                                          10. Leberfinger AN et al: Breast implant-associated anaplastic large cell lymphoma: a systematic review. JAMA Surg. 152(12):1161-8, 2017
                                                                          11. Mango VL et al: Breast carcinoma in augmented breasts: MRI findings. AJR Am J Roentgenol. 204(5):W599-604, 2015
                                                                          12. Noels EC et al: Breast implants and the risk of breast cancer: a meta-analysis of cohort studies. Aesthet Surg J. 35(1):55-62, 2015
                                                                          13. Albornoz CR et al: A paradigm shift in U.S. Breast reconstruction: increasing implant rates. Plast Reconstr Surg. 131(1):15-23, 2013
                                                                          14. Lavigne E et al: Breast cancer detection and survival among women with cosmetic breast implants: systematic review and meta-analysis of observational studies. BMJ. 346:f2399, 2013
                                                                          15. U.S. Food and Drug Administration: FDA medical device safety communication: reports of anaplastic large cell lymphoma (ALCL) in women with breast implants. http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm240000.htm. Accessed May 25, 2013
                                                                          16. Aladily TN et al: Breast implant-associated anaplastic large cell lymphoma: a newly recognized entity that needs further refinement of its definition. Leuk Lymphoma. 53(4):749-50, 2012
                                                                          17. Kronowitz SJ: Current status of implant-based breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg. 130(4):513e-523e, 2012
                                                                          18. Lavigne E et al: Do breast implants adversely affect prognosis among those subsequently diagnosed with breast cancer? Findings from an extended follow-up of a Canadian cohort. Cancer Epidemiol Biomarkers Prev. 21(10):1868-76, 2012
                                                                          19. Pan SY et al: Canadian breast implant cohort: extended follow-up of cancer incidence. Int J Cancer. 131(7):E1148-57, 2012
                                                                          20. Lipworth L et al: Cancer among Scandinavian women with cosmetic breast implants: a pooled long-term follow-up study. Int J Cancer. 124(2):490-3, 2009
                                                                          21. Handel N et al: Breast cancer diagnosis and prognosis in augmented women. Plast Reconstr Surg. 118(3):587-93; discussion 594-6, 2006
                                                                          22. Brown SL et al: Breast implant adverse events during mammography: reports to the Food and Drug Administration. J Womens Health (Larchmt). 13(4):371-8; discussion 379-80, 2004
                                                                          23. Miglioretti DL et al: Effect of breast augmentation on the accuracy of mammography and cancer characteristics. JAMA. 291(4):442-50, 2004
                                                                          24. Hoshaw SJ et al: Breast implants and cancer: causation, delayed detection, and survival. Plast Reconstr Surg. 107(6):1393-407, 2001
                                                                          25. Handel N et al: Factors affecting mammographic visualization of the breast after augmentation mammaplasty. JAMA. 268(14):1913-7, 1992
                                                                          26. Breast Implant-Associated Anaplastic Large Cell Lymphoma