Breast implant-associated anaplastic large cell lymphoma following prophylactic mastectomy & breast reconstruction: a...

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare T-cell lymphoma increasingly linked to textured breast implants. It typically presents as a late-onset periprosthetic seroma and carries a generally favorable prognosis when diagnosed early. However, its pathogenesis remains incompletely understood, particularly in patients with genetic cancer predispositions.

We report a unique case of BIA-ALCL in a 41-year-old woman who underwent bilateral prophylactic mastectomy and subsequent implant-based reconstruction due to a strong family history of breast and ovarian cancer. Ten years post-reconstruction, she presented with progressive unilateral breast swelling. Imaging suggested implant rupture with associated periprosthetic fluid. Cytology and immunohistochemistry confirmed CD30-positive, ALK-negative large T-cell lymphoma. PET-CT and MRI demonstrated disease confined to the implant capsule without lymph node involvement. Surgical management included bilateral en bloc capsulectomy. Histopathological staging revealed pT2N0M0 (Stage IB) disease due to superficial capsular infiltration. No adjuvant therapy was required because of the early intervention. Six-month follow-up imaging was negative for recurrence.

This case raises important considerations about cancer risk management in genetically predisposed individuals, especially regarding the safety profile of textured implants. Current evidence suggests a possible oncogenic interaction between hereditary susceptibility and chronic implant-associated inflammation.

Clinicians must maintain vigilance for BIA-ALCL even in prophylactic settings, as early diagnosis and complete surgical excision remain key to favorable outcomes.