Lymph node cancer with breast prostheses very rare

All plastic surgeons register their operations with breast implants in the DBIR (Dutch Breast Implant Registry)

Early detection and treatment of anaplastic large T cell lymphoma associated with breast implants (BIA-ALCL) is highly possible and essential for a good survival rate (90-95%).

Mintsje de Boer’s doctoral research maps the risks of anaplastic large cell lymphoma associated with breast implants (BIA-ALCL). De Boer, doctoral student and plastic surgeon and reconstructor in training at Maastricht UMC +, shows that women with a breast prosthesis have a much higher risk of developing this disease than women without a prosthesis. However, the absolute risk of a woman with breast prostheses falling ill before her 75th birthday is very low: 1 in 7,000. Doctoral research has provided important information on various aspects of BIA-ALCL, which were used to formulate a global policy on BIA-ALCL and to optimally inform patients. This thesis shows how important multidisciplinary collaboration and good registration of breast prostheses is to monitor understanding of prostheses and associated complications, as are done in the Netherlands by the Dutch consortium BIA-ALCL and the Dutch breast implant registry ( DBIR).

Patient information comes first
BIA-ALCL is a form of lymphoma that occurs in the fluid or capsule around a breast prosthesis. De Boer: “Women choose breast implants for very good reasons and for most women it increases their quality of life tremendously. In the Netherlands, 1 in 30 women have a breast prosthesis. This represents around 200,000 women in the Netherlands. The results of De Boer’s study form the basis of adequate patient information for these women. “The risk of BIA-ALCL is very low (1 in 7,000 before age 75), so there is no need to panic for women with breast implants. In comparison, the risk of developing breast cancer in the Netherlands is around 1 in 7. We tell women that if the breast gets bigger with a breast prosthesis or if a lump can be felt, it is important to ” deepen the investigation. Plastic surgeons are also much more aware of the symptoms of LAGC-AIM thanks to better information from research-in-practice, so the disease is more often detected early. Full recovery can be achieved for 90-95% of women with early and adequate treatment.

Future research
The research was carried out by the multidisciplinary Dutch consortium BIA-ALCL, which consists of plastic surgeons from Maastricht and Twente, epidemiologists and hematologists from Antoni van Leeuwenhoek and pathologists from Amsterdam UMC and is supported by the Dutch Association for Plastic Surgery (NVPC). Member of the research consortium, Prof. dr. Dr René van der Hulst from MUMC + underlines the importance of the results, but also indicates that not all questions have been answered yet. “We don’t yet know why women with breast prostheses get BIA-ALCL. For example, there is some evidence that women with an increased inherited risk of breast cancer have an increased risk of BIA-ALCL, but our rather small study in this area has yet to be confirmed by others.

The importance of a good registration
What is also underlined in the thesis is the great importance of the registration of breast prostheses to monitor prosthesis-related complications. In the Netherlands there is the DBIR (introduced by the NVPC) for this purpose. This register is unique in the world. All plastic surgeons record their operations with breast implants in the DBIR. The DBIR monitors the quality and associated complications. In addition, the DBIR allows the tracing of patients when a recall is required. “Tracking a good registration in DBIR and what information we can derive from it will provide reliable information in the future and will, for example, identify prostheses where BIA-ALCL is less common,” says de Boer. .