Breast Implant-Associated Anaplastic Large Cell Lymphoma in Australia and New Zealand: High-Surface-Area Textured Implants Are Associated with Increased Risk

Anna Loch-Wilkinson, Kenneth Beath, Robert John William Knight, William Louis Fick Wessels, Mark Magnusson, Tim Papadopoulos, Tony Connell, Julian Lofts, Michelle Locke, Ingrid Hopper, Rodney Cooter, Karen Vickery, Preeti Avinash Joshi, H. Miles Prince, Anand K. Deva

Research output: Contribution to journalArticleResearchpeer-review

Abstract

BACKGROUND: The association between breast implants and breast implant-associated anaplastic large cell lymphoma (ALCL) has been confirmed. Implant-related risk has been difficult to estimate to date due to incomplete datasets.

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 (i.e., Mentor, Allergan, and Silimed) dating back to 1999 were secured to estimate implant-specific risk.

RESULTS: Fifty-five cases of breast implant-associated ALCL were diagnosed in Australia and New Zealand between 2007 and 2016. The mean age of patients was 47.1 years and the mean time of implant exposure was 7.46 years. There were four 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 used (85.3 percent). Biocell salt loss textured (Allergan, Inamed, and McGhan) implants accounted for 58.7 percent of the implants used in this series. Comparative analysis showed the risk of developing breast implant-associated ALCL to be 14.11 times higher with Biocell textured implants and 10.84 higher with polyurethane (Silimed) textured implants compared with Siltex textured implants.

CONCLUSIONS: This study has calculated implant-specific risk of breast implant-associated ALCL. Higher-surface-area textured implants have been shown to significantly increase the risk of breast implant-associated ALCL in Australia and New Zealand. The authors present a unifying hypothesis to explain these observations.

Original languageEnglish
Pages (from-to)645-654
Number of pages10
JournalPlastic and Reconstructive Surgery
Volume140
Issue number4
DOIs
Publication statusPublished - 1 Oct 2017

Keywords

  • breast implants
  • Anaplastic large cell lymphoma
  • Epidemiology

Cite this

Loch-Wilkinson, Anna ; Beath, Kenneth ; Knight, Robert John William ; Wessels, William Louis Fick ; Magnusson, Mark ; Papadopoulos, Tim ; Connell, Tony ; Lofts, Julian ; Locke, Michelle ; Hopper, Ingrid ; Cooter, Rodney ; Vickery, Karen ; Joshi, Preeti Avinash ; Prince, H. Miles ; Deva, Anand K. / Breast Implant-Associated Anaplastic Large Cell Lymphoma in Australia and New Zealand : High-Surface-Area Textured Implants Are Associated with Increased Risk. In: Plastic and Reconstructive Surgery. 2017 ; Vol. 140, No. 4. pp. 645-654.
@article{e22d8ad4885f480bbc1f162dbf02cba1,
title = "Breast Implant-Associated Anaplastic Large Cell Lymphoma in Australia and New Zealand: High-Surface-Area Textured Implants Are Associated with Increased Risk",
abstract = "BACKGROUND: The association between breast implants and breast implant-associated anaplastic large cell lymphoma (ALCL) has been confirmed. Implant-related risk has been difficult to estimate to date due to incomplete datasets.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 (i.e., Mentor, Allergan, and Silimed) dating back to 1999 were secured to estimate implant-specific risk.RESULTS: Fifty-five cases of breast implant-associated ALCL were diagnosed in Australia and New Zealand between 2007 and 2016. The mean age of patients was 47.1 years and the mean time of implant exposure was 7.46 years. There were four 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 used (85.3 percent). Biocell salt loss textured (Allergan, Inamed, and McGhan) implants accounted for 58.7 percent of the implants used in this series. Comparative analysis showed the risk of developing breast implant-associated ALCL to be 14.11 times higher with Biocell textured implants and 10.84 higher with polyurethane (Silimed) textured implants compared with Siltex textured implants.CONCLUSIONS: This study has calculated implant-specific risk of breast implant-associated ALCL. Higher-surface-area textured implants have been shown to significantly increase the risk of breast implant-associated ALCL in Australia and New Zealand. The authors present a unifying hypothesis to explain these observations.",
keywords = "breast implants, Anaplastic large cell lymphoma, Epidemiology",
author = "Anna Loch-Wilkinson and Kenneth Beath and Knight, {Robert John William} and Wessels, {William Louis Fick} and Mark Magnusson and Tim Papadopoulos and Tony Connell and Julian Lofts and Michelle Locke and Ingrid Hopper and Rodney Cooter and Karen Vickery and Joshi, {Preeti Avinash} and Prince, {H. Miles} and Deva, {Anand K.}",
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Loch-Wilkinson, A, Beath, K, Knight, RJW, Wessels, WLF, Magnusson, M, Papadopoulos, T, Connell, T, Lofts, J, Locke, M, Hopper, I, Cooter, R, Vickery, K, Joshi, PA, Prince, HM & Deva, AK 2017, 'Breast Implant-Associated Anaplastic Large Cell Lymphoma in Australia and New Zealand: High-Surface-Area Textured Implants Are Associated with Increased Risk' Plastic and Reconstructive Surgery, vol. 140, no. 4, pp. 645-654. https://doi.org/10.1097/PRS.0000000000003654

Breast Implant-Associated Anaplastic Large Cell Lymphoma in Australia and New Zealand : High-Surface-Area Textured Implants Are Associated with Increased Risk. / Loch-Wilkinson, Anna; Beath, Kenneth; Knight, Robert John William ; Wessels, William Louis Fick ; Magnusson, Mark; Papadopoulos, Tim ; Connell, Tony ; Lofts, Julian ; Locke, Michelle ; Hopper, Ingrid; Cooter, Rodney; Vickery, Karen; Joshi, Preeti Avinash ; Prince, H. Miles; Deva, Anand K.

In: Plastic and Reconstructive Surgery, Vol. 140, No. 4, 01.10.2017, p. 645-654.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Breast Implant-Associated Anaplastic Large Cell Lymphoma in Australia and New Zealand

T2 - High-Surface-Area Textured Implants Are Associated with Increased Risk

AU - Loch-Wilkinson, Anna

AU - Beath, Kenneth

AU - Knight, Robert John William

AU - Wessels, William Louis Fick

AU - Magnusson, Mark

AU - Papadopoulos, Tim

AU - Connell, Tony

AU - Lofts, Julian

AU - Locke, Michelle

AU - Hopper, Ingrid

AU - Cooter, Rodney

AU - Vickery, Karen

AU - Joshi, Preeti Avinash

AU - Prince, H. Miles

AU - Deva, Anand K.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - BACKGROUND: The association between breast implants and breast implant-associated anaplastic large cell lymphoma (ALCL) has been confirmed. Implant-related risk has been difficult to estimate to date due to incomplete datasets.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 (i.e., Mentor, Allergan, and Silimed) dating back to 1999 were secured to estimate implant-specific risk.RESULTS: Fifty-five cases of breast implant-associated ALCL were diagnosed in Australia and New Zealand between 2007 and 2016. The mean age of patients was 47.1 years and the mean time of implant exposure was 7.46 years. There were four 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 used (85.3 percent). Biocell salt loss textured (Allergan, Inamed, and McGhan) implants accounted for 58.7 percent of the implants used in this series. Comparative analysis showed the risk of developing breast implant-associated ALCL to be 14.11 times higher with Biocell textured implants and 10.84 higher with polyurethane (Silimed) textured implants compared with Siltex textured implants.CONCLUSIONS: This study has calculated implant-specific risk of breast implant-associated ALCL. Higher-surface-area textured implants have been shown to significantly increase the risk of breast implant-associated ALCL in Australia and New Zealand. The authors present a unifying hypothesis to explain these observations.

AB - BACKGROUND: The association between breast implants and breast implant-associated anaplastic large cell lymphoma (ALCL) has been confirmed. Implant-related risk has been difficult to estimate to date due to incomplete datasets.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 (i.e., Mentor, Allergan, and Silimed) dating back to 1999 were secured to estimate implant-specific risk.RESULTS: Fifty-five cases of breast implant-associated ALCL were diagnosed in Australia and New Zealand between 2007 and 2016. The mean age of patients was 47.1 years and the mean time of implant exposure was 7.46 years. There were four 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 used (85.3 percent). Biocell salt loss textured (Allergan, Inamed, and McGhan) implants accounted for 58.7 percent of the implants used in this series. Comparative analysis showed the risk of developing breast implant-associated ALCL to be 14.11 times higher with Biocell textured implants and 10.84 higher with polyurethane (Silimed) textured implants compared with Siltex textured implants.CONCLUSIONS: This study has calculated implant-specific risk of breast implant-associated ALCL. Higher-surface-area textured implants have been shown to significantly increase the risk of breast implant-associated ALCL in Australia and New Zealand. The authors present a unifying hypothesis to explain these observations.

KW - breast implants

KW - Anaplastic large cell lymphoma

KW - Epidemiology

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DO - 10.1097/PRS.0000000000003654

M3 - Article

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JO - Plastic and Reconstructive Surgery

JF - Plastic and Reconstructive Surgery

SN - 0032-1052

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