Breast implant associated Anaplastic Large Cell Lymphoma in Australia and New Zealand - high surface area textured implants are associated with increased risk.

Background: The association between breast implants and breast implant associated anaplastic large cell lymphoma (BIA-ALCL), has been confirmed. Implant related risk has been difficult to estimate due to incomplete or unknown implant histories and lack of clarity on the number of implants utilized. Methods: All cases in Australia and New Zealand were identified and analyzed. Textured implants reported in this group were subjected to surface area analysis. Sales data from three leading breast implant manufacturers (Mentor/Allergan/Silimed) dating back to 1999 were secured to estimate implant specific risk. Results: 55 cases of BIA-ALCL were diagnosed in Australia and New Zealand between 2007 and 2016. The mean age of patients was 47.1 and the mean time of implant exposure was 7.46 years. There were 4 deaths in the series related to mass and/or metastatic presentation. All patients were exposed to textured implants. Surface area analysis confirmed that higher surface area was associated with 64 of the 75 implants utilized (85.3%). Biocell salt loss textured (Allergan/Inamed/McGhan) accounted for 58.7% of implants utilized in this series. Comparative analysis showed the risk of developing BIA-ALCL was found to be 14.11 times higher with Biocell textured implants and 10.84 higher with polyurethane (Silimed) textured implants as compared with Siltex textured implants. Conclusion: This study has calculated implant specific risk of BIA-ALCL. Higher surface area textured implants have been shown to significantly increase risk of BIA-ALCL in Australia and New Zealand. We present a unifying hypothesis to explain these observations. (C)2017American Society of Plastic Surgeons

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