Breast implant-associated anaplastic large cell lymphoma with contralateral invasive lobular carcinoma

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare type of T-cell lymphoma that arises in the setting of textured breast implants. In this case report, a 69-year-old woman with a remote history of right-sided invasive lobular carcinoma status post right mastectomy and bilateral breast reconstruction presents with spontaneous right breast swelling and pain, suspicious for implant rupture. Diagnostic MRI revealed a peri-implant fluid collection in the right breast and focal nonmass enhancement in the left breast. The patient was ultimately diagnosed with right-sided BIA-ALCL and left-sided invasive lobular carcinoma. Although intravenous gadolinium contrast is not needed to assess implant integrity, it can be used to evaluate for malignancy when the patient is at an increased risk for developing breast cancer. In this case, the use of contrast revealed the rare instance of a synchronous contralateral invasive lobular carcinoma. Despite the rarity of BIA-ALCL with an estimated incidence of 1:30,000 in women with textured implants, it is essential that radiologists include this entity in the differential in the appropriate clinical setting as surgical resection is curative if performed before the disease has spread.