[The Janus face of breast implant diseases II.]

In modern plastic surgery, breast implants are an indispensable surgical tool in both reconstructive and cosmetic procedures. The clear positive effect of implantation is that it improves body image and thus self-esteem, but over the past twenty years, alongside its successful use, a downside to implants has emerged, known in medical literature as implant diseases. These are autoimmune breast implant illness (BII), breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and breast implant-associated squamous cell carcinoma (BIA-SCC). BIA-ALCL is a rare but well-defined syndrome, an anaplastic, CD30+ T-cell non-Hodgkin lymphoma, primarily associated with textured surface implants. The disease usually develops later, 8-12 years after implantation, and local symptoms (late seroma, breast shape change, asymmetry, etc.) are dominant. In advanced stage III and IV cases, systemic symptoms such as chronic fatigue, fever, night sweats, and regional lymph node or distant metastases (e.g., chest wall, liver, small intestine, bone marrow) may also develop. In localized BIA-ALCL, en bloc explantation and capsulectomy are often curative and no further adjuvant treatment is necessary. In stages II-IV, postoperative adjuvant chemo-radiotherapy and biological treatment are also necessary. Treatment protocols for the disease emphasize a multidisciplinary approach, with plastic surgeons, oncologists, radiologists, pathologists, and psychologists all participating in patient care. This holistic approach improves long-term therapeutic outcomes and patients' quality of life. This study, which reviews international literature and considers local practical data, presents the immunological processes, epidemiological, clinical, and surgical factors underlying these processes. Orv Hetil. 2026; 167(40): 1605-1615.