Breast Implant-Associated Anaplastic Large Cell Lymphoma Incidence: Determining an Accurate Risk

Jonas A. Nelson*, Stefan Dabic, Babak J. Mehrara, Peter G. Cordeiro, Joseph J. Disa, Andrea L. Pusic, Evan Matros, Joseph H. Dayan, Robert J. Allen, Michelle Coriddi, Thais O. Polanco, Meghana G. Shamsunder, Itay Wiser, Monica Morrow, Ahmet Dogan, Michele R. Cavalli, Elizabeth Encarnacion, Meghan E. Lee, Colleen M. McCarthy

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective:This study sought to estimate the incidence and incidence rate of breast implant-Associated anaplastic large cell lymphoma (BIA-ALCL) at a high-volume single institution, which enables vigorous long-Term follow-up and implant tracking for more accurate estimates.Summary Background Data:The reported incidence of BIA-ALCL is highly variable, ranging from 1 in 355 to 1 in 30,000 patients, demonstrating a need for more accurate estimates.Methods:All patients who underwent implant-based breast reconstruction from 1991 to 2017 were retrospectively identified. The incidence and incidence rate of BIA-ALCL were estimated per patient and per implant. A time-To-event analysis was performed using the Kaplan-Meier estimator and life table.Results:During the 26-year study period, 9373 patients underwent reconstruction with 16,065 implants, of which 9589 (59.7%) were textured. Eleven patients were diagnosed with BIA-ALCL, all of whom had a history of textured implants. The overall incidence of BIA-ALCL was 1.79 per 1000 patients (1 in 559) with textured implants and 1.15 per 1000 textured implants (1 in 871), with a median time to diagnosis of 10.3 years (range, 6.4-15.5 yrs). Time-To-event analysis demonstrated a BIA-ALCL cumulative incidence of 0 at up to 6 years, increasing to 4.4 per 1000 patients at 10 to 12 years and 9.4 per 1000 patients at 14 to 16 years, although a sensitivity analysis showed loss to follow-up may have skewed these estimates.Conclusions:BIA-ALCL incidence and incidence rates may be higher than previous epidemiological estimates, with incidence increasing over time, particularly in patients exposed to textured implants for longer than 10 years.

Original languageEnglish
Pages (from-to)403-409
Number of pages7
JournalAnnals of Surgery
Issue number3
StatePublished - 1 Sep 2020
Externally publishedYes


  • ALCL
  • breast cancer
  • breast implant-Associated anaplastic large cell lymphoma
  • breast reconstruction
  • textured implants


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