2024 EURAPS Expert Consensus on breast implant associated-anaplastic large cell lymphoma

BACKGROUND: Despite nearly three decades of investigation since its initial report, breast implant associated-anaplastic large cell lymphoma (BIA-ALCL) remains an elusive and evolving clinical entity.

OBJECTIVES: This manuscript presents multidisciplinary consensus recommendations on BIA-ALCL, developed under the auspices of the European Association of Plastic Surgeons (EURAPS). The guidance is intended for all clinicians involved in implanting, managing, and monitoring patients with breast implants, regardless of specialty or indication.

METHODS: A literature search was conducted up to November 2023 across PubMed, Scopus, Web of Science, and Google Scholar databases, focusing on epidemiologic, etiologic, pathogenic, diagnostic and therapeutic aspects of BIA-ALCL. Non-English articles, non-human studies, and studies unrelated to breast implants or BIA-ALCL were excluded. A Delphi process was conducted involving 24 panelists, with 4 web-based meetings and email-based questionnaires to record the agreement level with 28 statements based on research questions, using a 5-point Likert Scale. Median response, interquartile range and comments were used to accept, reject or revise each statement.

RESULTS: Of 1025 publications initially identified, 519 met the inclusion criteria. These informed the development of 28 statements across 3 chapters: "epidemiology and causality", "etiopathogenesis and diagnosis" and "treatment". Consensus was achieved on all statements.

CONCLUSION: BIA-ALCL prevalence in patients with textured implants is significantly higher than previously believed. Over time, mandatory opt-out implant registries will be crucial for clarifying BIA-ALCL epidemiology. Etiopathogenesis remains unclear, but patients can be stratified by risk of onset. Total capsulectomy may be considered a risk-reducing procedure, depending on individual patient preferences and clinical judgment.