BIA-ALCL: Breast Implant-Associated Anaplastic Large Cell Lymphoma

The objective of this chapter is to provide a comprehensive overview of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), an uncommon breast implant-associated neoplasia. BIA-ALCL, often linked to macrotextured implants, has been extensively debated in recent years, especially regarding diagnostic and therapeutic management. There is ongoing debate regarding its etiopathogenesis and prevalence. Anaplastic large cell lymphoma associated with breast implants (BIA-ALCL) is a rare form of non-Hodgkin’s lymphoma (NHL), specifically, a subtype of T-cell lymphoma. In 2016, the World Health Organization (WHO) first recognized BIA-ALCL as a distinct disease entity. The most common clinical presentations of BIA-ALCL are late seroma and breast swelling. Large lymphoid cells with abundant cytoplasm and pleomorphic characteristics, such as horseshoe-shaped or kidney-shaped nuclei, are characteristic. Genetic mutations like JAK-STAT pathway activation have been outlined as a dominant signature of BIA-ALCL. To date, the mainstay of treatment for BIA-ALCL is implant removal with en bloc capsulectomy. BIA-ALCL is typically associated with an indolent course and favorable prognosis. A multidisciplinary team and an early diagnosis are essential for proper patient and disease management. To date, prophylactic implant explantation in asymptomatic patients is not recommended. The incidence and etiopathogenesis of the disease remain controversial topics in the literature due to a dearth of pertinent data. Promoting national registries is necessary to facilitate the collection of pertinent data and foster research in the field.