Breast implant-associated B-cell lymphomas: First systematic review of the literature

Although breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a T-cell lymphoma, is well characterized, recent reports have highlighted B-cell lymphomas associated with breast implants, a less understood and distinct entity.

This systematic review aimed to investigate breast implant-associated B-cell lymphomas (BIA-BCL) by analyzing their clinical presentation, diagnostic workup, histopathology, management, and prognosis.

A comprehensive literature search was performed in the PubMed, Cochrane, Embase, and Google Scholar databases following the PRISMA guidelines. Studies reporting B-cell lymphomas linked to breast implants were included. Additionally, a new case of diffuse large B-cell lymphoma (DLBCL) related to breast implants was added.

Twenty-seven studies describing 37 patients were identified; our case raised the total to 38. Eleven B-cell lymphoma subtypes were found, predominantly diffuse large B-cell lymphoma (n=27). Implant texture was smooth in 5 cases, with an average latency of 17 years post-implantation. Common symptoms included contracture (n=23) and pain (n=22), co-occurring in 16 patients. Preoperative imaging was performed in 24 patients and a biopsy or fluid collection in 12, enabling diagnosis before surgery in 11 cases. Treatments varied: 3 patients received medical therapy only and 21 received surgery without further treatment.

BIA-BCLs are a heterogeneous group distinct from BIA-ALCL, occurring with smooth and textured implants. DLBCL is the most frequent subtype. Given the limited data, en bloc excision of the implant and surrounding capsule is recommended as the first-line treatment. Larger studies are needed to refine diagnosis and management.