ABSTRACT
PURPOSE: Breast implant-associated anaplastic large-cell lymphoma (ALCL) is a recently described clinicopathologic entity that usually presents as an effusion-associated fibrous capsule surrounding an implant. Less frequently, it presents as a mass. The natural history of this disease and long-term outcomes are unknown. PATIENTS AND METHODS: We reviewed the literature for all published cases of breast implant-associated ALCL from 1997 to December 2012 and contacted corresponding authors to update clinical follow-up. RESULTS: The median overall survival (OS) for 60 patients was 12 years (median follow-up, 2 years; range, 0-14 years). Capsulectomy and implant removal was performed on 56 of 60 patients (93%). Therapeutic data were available for 55 patients: 39 patients (78%) received systemic chemotherapy, and of the 16 patients (28%) who did not receive chemotherapy, 12 patients opted for watchful waiting and four patients received radiation therapy alone. Thirty-nine (93%) of 42 patients with disease confined by the fibrous capsule achieved complete remission, compared with complete remission in 13 (72%) of 18 patients with a tumor mass. Patients with a breast mass had worse OS and progression-free survival (PFS; P = .052 and P = .03, respectively). The OS or PFS were similar between patients who received and did not receive chemotherapy (P = .44 and P = .28, respectively). CONCLUSION: Most patients with breast implant-associated ALCL who had disease confined within the fibrous capsule achieved complete remission. Proper management for these patients may be limited to capsulectomy and implant removal. Patients who present with a mass have a more aggressive clinical course that may be fatal, justifying cytotoxic chemotherapy in addition to removal of implants.
Subject(s)
Breast Implants/adverse effects , Breast Neoplasms/etiology , Lymphoma, Large-Cell, Anaplastic/etiology , Adult , Aged , Aged, 80 and over , Breast/drug effects , Breast/pathology , Breast/surgery , Breast Neoplasms/diagnosis , Breast Neoplasms/therapy , Device Removal/statistics & numerical data , Disease-Free Survival , Drug Therapy/methods , Drug Therapy/statistics & numerical data , Female , Follow-Up Studies , Humans , Lymphoma, Large-Cell, Anaplastic/diagnosis , Lymphoma, Large-Cell, Anaplastic/therapy , Middle Aged , Time Factors , Watchful Waiting/statistics & numerical dataABSTRACT
BACKGROUND: There is relatively scant evidence concerning radiation effects on reduction mammaplasty and mastopexy, two procedures which are often used in the irradiated breast to restore symmetry following breast-conserving therapy (BCT). OBJECTIVE: The purpose of this study is to further examine outcomes of reduction mammaplasty and mastopexy in breast cancer patients previously treated with BCT and radiation. METHODS: A retrospective search at Baystate Medical Center (Springfield, MA) identified 12 patients who had received external beam radiation and either reduction mammaplasty or mastopexy. Overall radiation doses, including tumor bed boost, ranged from 5000 to 6600 cGy. The mean time between completion of radiation therapy and asymmetry correction was 63 months (range, 5 to 169 months). An overall average of 910 g of tissue was removed from the irradiated breast (range, 180 to 2925 g). The average length follow-up after asymmetry correction was 9 months (range, 1 to 44 months). RESULTS: In our patients, there were no major complications such as flap loss, tissue necrosis, heavy scarring, infection, or severe deformity. Minor complications in the irradiated breast occurred in 25% of patients and included prolonged edema (n = 1), delayed wound closure (n = 1), and minor scarring (n = 1). Histopathology was unremarkable except for one patient who was found to have recurrent ductal carcinoma in situ. CONCLUSIONS: In the cases reviewed, we did not observe any complications commonly associated with operating in an irradiated field. Good cosmesis and acceptable symmetry were achieved in all patients. Our data suggest that reduction mammaplasty and mastopexy after radiation therapy are relatively safe procedures with risks not significantly higher than either operation performed in patients without radiation.
Subject(s)
Breast Neoplasms/radiotherapy , Mammaplasty/methods , Postoperative Complications/prevention & control , Adult , Breast/anatomy & histology , Breast/radiation effects , Breast Neoplasms/surgery , Cicatrix/etiology , Combined Modality Therapy , Female , Humans , Longitudinal Studies , Mammaplasty/adverse effects , Mastectomy, Segmental/adverse effects , Mastectomy, Segmental/methods , Middle Aged , Retrospective StudiesABSTRACT
Disorders of fatty tissue metabolism and body contour are frequently described in the literature. Several different syndromes have been ascribed to recurring characteristics of fatty deposition with similar underlying etiologies. These syndromes can generally be classified into the lipomatoses (abnormal accumulations of fat) and the lipodystrophies (abnormal fat atrophy). The authors describe a case of isolated symmetrical lipomatosis of the soft tissue overlying the trochanters that developed a recurrence after treatment with liposuction. They have attempted to match this patient's disorder into 1 of several reported syndromes, with benign symmetric lipomatosis and acquired partial lipodystrophy at the top of the differential diagnosis. However, some characteristics of this patient may warrant a separate categorization for her condition. In this case report, the current literature on disorders of fatty tissue metabolism is reviewed and a discussion of relevant factors and issues surrounding their clinical significance and management is provided.
