A Further Case Report from the United Kingdom of Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) and a Reason to Avoid the Subpectoral Plane

Breast Augmentation is only second to liposuction as the most commonly performed Aesthetic Surgery procedure in the United Kingdom with a “guestimated” 50,000 cases per annum. Silicone elastomer shells containing silicone gel implants have been used continuously for over 50 years in the UK. Recently Anaplastic Large Cell Lymphoma (BIA-ALCL) has been associated in women having breast implants with variants of a disease process that may remain intracapsular and resolved by removal of implant and total capsulectomy, or nodular and metastatic with proven risk of mortality. An MHRA ‘advisory notice’ merely confirms the views of the MHRA that breast augmentation is safe, nothing needs to be done for existing augmented patients and even if a women develops this condition it can be successfully treated. However there have been nine deaths from BIA-ALCL and actually what Surgeons urgently need is advice on best management protocol and encouragement for international collaboration and evidence based medicine. Diagnosis of BIA-ALCL is dependent upon awareness, correct diagnostic immune staining techniques and review by knowledgeable histopathologists. Recommendations on management of BIA-ALCL should follow the guidelines of Kim et al in 2015. It is important to collect data and outcomes on such patients. The use of submuscular plane for primary breast augmentation should be carefully reconsidered in ensuring safe and complete capsulectomy in the event of BIA-ALCL.