Breast Implant Associated-Squamous Cell Carcinoma (BIA-SCC)

Breast Implant Associated-Squamous Cell Carcinoma (BIA-SCC) BIA-SCC and BIA-ALCL are two rare conditions that are associated with breast implants. BIA-SCC is a type of squamous cell carcinoma that is associated with the breast implant capsule and can be invasive. BIA-ALCL is a type of T-cell lymphoma that can develop around the breast implant. Both types […]

Breast Implant Associated-Squamous Cell Carcinoma (BIA-SCC)

BIA-SCC and BIA-ALCL are two rare conditions that are associated with breast implants. BIA-SCC is a type of squamous cell carcinoma that is associated with the breast implant capsule and can be invasive. BIA-ALCL is a type of T-cell lymphoma that can develop around the breast implant. Both types of cancer are not cancer of the breast tissue itself. The number of known cases of BIA-SCC is significantly lower than that of BIA-ALCL. The lifetime risk of BIA-SCC is unknown, while the lifetime risk of BIA-ALCL varies widely. The age at presentation and average length since initial implantation are similar for both conditions. BIA-SCC has been associated with both smooth and textured implants, while BIA-ALCL has only been associated with textured implants. The presentation and diagnosis of BIA-SCC and BIA-ALCL are different, as is the treatment. Explantation with complete capsulectomy is the recommended treatment for both conditions. It is essential to be aware of the signs and symptoms of implant-associated complications such as BIA-SCC and BIA-ALCL and to report them promptly to your surgeon or healthcare provider. It is also a good idea to ask your surgeon about the type and surface of the implant you are getting, as well as the risks and benefits associated with each type of implant. Lastly, it is essential to have realistic expectations and to consider your personal motivations for getting breast implants.

 

  BIA-SCC BIA-ALCL
What is it? Breast implant-associated squamous cell carcinoma (BIA-SCC) is a very rare but potentially aggressive, epithelial-based tumor that appears to emanate from the breast implant capsule. Pathology shows sheets of squamous cells lining the capsule in nests and bundles. BIA-SCC can exhibit highly invasive properties including spread to lymph nodes, local tissues and distant sites, such as muscle and bone.

BIA-SCC is not a cancer of the breast tissue itself.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon and treatable type of T-cell lymphoma that can develop around breast implants. BIA-ALCL can exhibit highly invasive properties, including spread to lymph nodes, local tissues and distant sites.

BIA-ALCL is not a cancer of the breast tissue itself.

Number of Known Cases To the best of our knowledge, there are 16 cases reported in the literature Approximately 1,227 worldwide as of August 2022.
Lifetime Risk Unknown Current lifetime risk of BIA-ALCL varies widely (e.g., estimates of 1:2,207-1:86,029 based upon variable risk with different manufacturer types of textured implants. More recently, cumulative risk over 20 years in breast reconstruction patients implanted with Biocell devices was estimated at 1:100 (Cordeiro et al, 2020).
Age at presentation 55.8 years (range 40-81) 55.3 years (range 28-84)
Average length since initial implantation 22.74 years (range 11-40 years) 10.32 years (range 0.08-41 years)
Implant Surface In case reports, BIA-SCC has been reported in patients who have had smooth and/or textured implants. No cases of BIA-ALCL have been confirmed in patients who have only had smooth implants in case series, case reports or registries. However, it is not possible to exclude the appearance of BIA-ALCL in association with smooth implants at this time. The FDA states that all confirmed cases worldwide either have a history of a textured device or an incomplete clinical history available for review.
Implant Type BIA-SCC has been associated with both silicone and saline implants in aesthetic as well as reconstructive patients. BIA-ALCL has been associated with both silicone and saline implants in aesthetic as well as reconstructive patients.
Presentation    
• Delayed seroma Yes Yes
• Unilateral swelling Yes Yes
• Pain, erythema Yes Yes
• Capsular contracture Often Sometimes
Extracapsular spread at presentation 80% at presentation 28% at presentation
Typical Pathology Squamous cells in sheets with varying degrees of atypia and metaplasia and at least one focus of SCC. Lymphoma with mass confined to single area on capsule.
Diagnostic Assessment CK 5/6+; p63+; Flow cytometry + for squamous cells and keratin CD30+; ALK-; Flow cytometry + for T-cells
Imaging Ultrasound to evaluate for peri-prosthetic fluid +/- aspiration; MRI with and without contrast to evaluate capsule to rule out mass; PET-CT for extent of disease, if present. Ultrasound to evaluate for peri-prosthetic fluid +/- aspiration; PET CT is performed following a positive diagnosis. Mammograms are not helpful for evaluating lymphoma but are important for the evaluation of breast cancer.
Treatment Official treatment recommendations will need to be based on emerging data. At present, it appears that explantation with complete (en bloc) capsulectomy will provide the best outcomes.

Based on existing case reports, it appears that incomplete resection of BIA-SCC can result in early and/or aggressive recurrence.

In most cases, explantation with complete (en bloc) capsulectomy is curative. Incomplete capsular resection has been associated with both recurrence and significantly lower survival. Rare patients will present with more advanced diseases and may require radiotherapy and chemotherapy. The current treatment recommendation is for bilateral complete capsulectomy and implant removal, as a small number of women have had contralateral disease found incidentally.
Chemotherapy / Radiation Therapy Patients treated within these cases did not appear to respond. Responds to Brentuximab plus CT.
Mortality 43.8% at six months. 2.8% at one year.

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