Risk of Anaplastic Large-Cell Lymphoma (ALCL) in Cases of Late Seroma Formation After Breast Implant Insertion

Kun Hwang, MD, PhD; Hun Kim, PhD; Hyung Mook Kim, MD; Joo Ho Kim, MD

Disclosures

ePlasty. 2021;21:e4 

In This Article

Results

Among the 7 articles analyzed, 6 articles had follow-up length.[4,6–9,30] The average length of follow-up was 8.9 ± 5.3 years (range, 0.5–20 years).

1. Incidence of late seroma in patients who underwent breast implantation. Three articles reported the incidence of late seroma in patients who underwent breast implantation, with a total of 75 seromas in 48,211 implants (0.16%) (Table 1).[5–7]

2. Incidence of ALCL in patients who underwent breast implantation. One review article reported 48 cases of non-Hodgkin lymphoma (NHL) in 43,537 patients who underwent breast implantation (0.11%) (Table 2, top).[8] Another article stated that 11 patients had ALCL among 389 patients with primary lymphoma of the breast (2.83%) (Table 2, bottom).[9]

Primary lymphomas of the breast are almost always NHL, and only 29 cases of Hodgkin lymphoma were reported.[10–29] Thereafter, the incidence of ALCL among all breast implants was calculated by multiplying the incidence of NHL in breast implants by the incidence of ALCL in patients with breast lymphoma (48/43,537 × 11/389 × 100 = 0.0031%).

3. Frequency of seroma in ALCL patients. Two articles reported the frequency of seroma in ALCL patients, with a total of 143 seromas in 236 ALCLs (60.59%) (Table 3).[4–30]

4. Odds ratio and risk ratio of ALCL in patients with late seroma. Using the aforementioned incidence values, the OR and risk ratio (RR) were calculated (Figure 2, Table 2). The number of ALCLs in patients without seroma (n = 93) was calculated by subtracting the number of ALCLs in patients with seroma (n = 143) from the total number of ALCLs (N = 236). The total number of implant cases was estimated using the proportional expression of the incidence (0.0031%) of ALCL among breast implants (236 × 0.000031 = 7,612,903). The total number of seroma cases was estimated using the proportional expression of the incidence (0.16%) of late seroma among patients with breast implants (7,612,903 × 75/48,211 = 11,843). Then, the remaining blanks were filled by subtracting or adding the known numbers and the OR and RR were calculated.

Figure 2.

Relationships among breast implant, seroma, and ALCL. Seroma was found in 0.16% of patients with implants. ALCL was found in 0.0031% of patients with implants. Furthermore, 60.59% of ALCL patients had seroma. The expected incidence of ALCL in patients with seroma patients was 1.21%. ALCL indicates anaplastic large-cell lymphoma.

The risk of ALCL was significantly higher in patients with late seroma than in patients without seroma (OR = 998.93; 95% CI, 768.90–1297.78; P < .001; and RR = 986.88; 95% CI, 760.58–1280.53; P < .001).

5. Incidence of ALCL in patients with seroma. The incidence of ALCL in patients with seroma was calculated by dividing the number of cases of ALCL in patients with seroma (n = 143) by the total number of cases of seroma (N = 11,843), resulting in an incidence of 1.21% (Table 4).

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