UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Breast implant-associated anaplastic large cell lymphoma

Authors
Mark W Clemens, MD, FACS
Eric Jacobsen, MD
Section Editors
Charles E Butler, MD, FACS
Arnold S Freedman, MD
Deputy Editors
Kathryn A Collins, MD, PhD, FACS
Alan G Rosmarin, MD

INTRODUCTION

Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) is a rare peripheral T cell lymphoma arising around breast implants placed for either reconstructive or cosmetic indications. The association of breast implants with a cancer of the immune system has created understandable concern among patients, plastic surgeons, and oncologists.

Initial studies suggest that BI-ALCL follows a relatively indolent course in most patients and those with early stage disease have an excellent prognosis. However, reports of disseminated cancer and deaths attributed to the disease emphasize the importance of appropriate surveillance, timely diagnosis, and adequate treatment.

BI-ALCL is rarely seen at most medical centers, and thus a diagnosis of BI-ALCL can become delayed, often not being suspected and only diagnosed at the time of implant revision surgery performed for a persistent seroma. Thus, clinicians must maintain a high index of suspicion. BI-ALCL usually presents as localized disease with either a seroma or, less commonly, a discrete breast mass adjacent to the implant. Most cases present approximately one decade after implant placement, although earlier or later presentations can be seen.

The clinical features, diagnosis, treatment, and prognosis of BI-ALCL are reviewed here. The diagnosis and management of systemic ALCL (anaplastic lymphoma kinase [ALK]-positive and ALK-negative) and primary cutaneous ALCL are presented separately. (See "Clinical manifestations, pathologic features, and diagnosis of systemic anaplastic large cell lymphoma" and "Primary cutaneous anaplastic large cell lymphoma" and "Treatment of systemic anaplastic large cell lymphoma".)

CLASSIFICATION

Lymphoma is the most common hematologic malignancy and is a cancer of the immune system developing from B or T lymphocytes [1]. The peripheral T cell lymphomas are a heterogeneous group that are derived from cells that normally develop into T lymphocytes (cytotoxic T lymphocytes, helper T lymphocytes, or regulatory T lymphocytes). Peripheral T cell lymphomas constitute <15 percent of all lymphomas in adults. (See "Classification of the hematopoietic neoplasms", section on 'Lymphoid neoplasms'.)

                      

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Thu Nov 10 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. General Information About Adult Non-Hodgkin Lymphoma https://www.cancer.gov/types/lymphoma/patient/adult-nhl-treatment-pdq (Accessed on November 20, 2014).
  2. Swerdlow SH, Campo E, Pileri SA, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood 2016; 127:2375.
  3. Morris SW, Kirstein MN, Valentine MB, et al. Fusion of a kinase gene, ALK, to a nucleolar protein gene, NPM, in non-Hodgkin's lymphoma. Science 1994; 263:1281.
  4. Jacobsen E. Anaplastic large-cell lymphoma, T-/null-cell type. Oncologist 2006; 11:831.
  5. Kim B, Roth C, Chung KC, et al. Anaplastic large cell lymphoma and breast implants: a systematic review. Plast Reconstr Surg 2011; 127:2141.
  6. George EV, Pharm J, Houston C, et al. Breast implant-associated ALK-negative anaplastic large cell lymphoma: a case report and discussion of possible pathogenesis. Int J Clin Exp Pathol 2013; 6:1631.
  7. Bizjak M, Selmi C, Praprotnik S, et al. Silicone implants and lymphoma: The role of inflammation. J Autoimmun 2015; 65:64.
  8. Kim B, Roth C, Young VL, et al. Anaplastic large cell lymphoma and breast implants: results from a structured expert consultation process. Plast Reconstr Surg 2011; 128:629.
  9. Ferreri AJ, Govi S, Pileri SA, Savage KJ. Anaplastic large cell lymphoma, ALK-negative. Crit Rev Oncol Hematol 2013; 85:206.
  10. Orciani M, Sorgentoni G, Torresetti M, et al. MSCs and inflammation: new insights into the potential association between ALCL and breast implants. Breast Cancer Res Treat 2016; 156:65.
  11. Blombery P, Thompson ER, Jones K, et al. Whole exome sequencing reveals activating JAK1 and STAT3 mutations in breast implant-associated anaplastic large cell lymphoma anaplastic large cell lymphoma. Haematologica 2016; 101:e387.
  12. Yoshida SH, Swan S, Teuber SS, Gershwin ME. Silicone breast implants: immunotoxic and epidemiologic issues. Life Sci 1995; 56:1299.
  13. Jacombs A, Tahir S, Hu H, et al. In vitro and in vivo investigation of the influence of implant surface on the formation of bacterial biofilm in mammary implants. Plast Reconstr Surg 2014; 133:471e.
  14. Hu H, Jacombs A, Vickery K, et al. Chronic biofilm infection in breast implants is associated with an increased T-cell lymphocytic infiltrate: implications for breast implant-associated lymphoma. Plast Reconstr Surg 2015; 135:319.
  15. http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm481899.htm (Accessed on July 25, 2016).
  16. Brody GS, Deapen D, Taylor CR, et al. Anaplastic large cell lymphoma occurring in women with breast implants: analysis of 173 cases. Plast Reconstr Surg 2015; 135:695.
  17. Hu H, Johani K, Almatroudi A, et al. Bacterial Biofilm Infection Detected in Breast Implant-Associated Anaplastic Large-Cell Lymphoma. Plast Reconstr Surg 2016; 137:1659.
  18. Adams WP Jr. Discussion: Bacterial Biofilm Infection Detected in Breast Implant-Associated Anaplastic Large-Cell Lymphoma. Plast Reconstr Surg 2016; 137:1670.
  19. Brody GS. The Case against Biofilm as the Primary Initiator of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Plast Reconstr Surg 2016; 137:766e.
  20. Zakhary JM, Hamidian Jahromi A, Chaudhery S, Kim M. Anaplastic large cell lymphoma in the setting of textured breast implant: a call for patients and physicians education. J La State Med Soc 2013; 165:26.
  21. Lista F, Tutino R, Khan A, Ahmad J. Subglandular breast augmentation with textured, anatomic, cohesive silicone implants: a review of 440 consecutive patients. Plast Reconstr Surg 2013; 132:295.
  22. http://ansm.sante.fr/S-informer/Points-d-information-Points-d-information/Lymphome-Anaplasique-a-Grandes-Cellules-associe-aux-implants-mammaires-LAGC-AIM-Point-sur-les-investigations-en-cours-Point-d-Information (Accessed on July 25, 2016).
  23. Olack B, Gupta R, Brooks GS. Anaplastic large cell lymphoma arising in a saline breast implant capsule after tissue expander breast reconstruction. Ann Plast Surg 2007; 59:56.
  24. Lazzeri D, Agostini T, Bocci G, et al. ALK-1-negative anaplastic large cell lymphoma associated with breast implants: a new clinical entity. Clin Breast Cancer 2011; 11:283.
  25. de Jong D, Vasmel WL, de Boer JP, et al. Anaplastic large-cell lymphoma in women with breast implants. JAMA 2008; 300:2030.
  26. Vase MØ, Friis S, Bautz A, et al. Breast implants and anaplastic large-cell lymphoma: a danish population-based cohort study. Cancer Epidemiol Biomarkers Prev 2013; 22:2126.
  27. Largent J, Oefelein M, Kaplan HM, et al. Risk of lymphoma in women with breast implants: analysis of clinical studies. Eur J Cancer Prev 2012; 21:274.
  28. Brinton LA. The relationship of silicone breast implants and cancer at other sites. Plast Reconstr Surg 2007; 120:94S.
  29. Lipworth L, Tarone RE, McLaughlin JK. Breast implants and lymphoma risk: a review of the epidemiologic evidence through 2008. Plast Reconstr Surg 2009; 123:790.
  30. Miranda RN, Lin L, Talwalkar SS, et al. Anaplastic large cell lymphoma involving the breast: a clinicopathologic study of 6 cases and review of the literature. Arch Pathol Lab Med 2009; 133:1383.
  31. Clemens MW, Miranda RN. Coming of Age: Breast Implant-Associated Anaplastic Large Cell Lymphoma After 18 Years of Investigation. Clin Plast Surg 2015; 42:605.
  32. Clemens MW, Collins MS, Butler CE, et al. Characteristics and Treatment of Patients with Breast Implant-Associated Anaplastic Large Cell Lymphoma Presenting with Aggressive Features. Plast Reconstr Surg 2015; 136:119.
  33. Letter H, Rop B, Edison MN, Turner P. Breast Implant-Associated Anaplastic Large Cell Lymphoma: A Case Report and Literature Review. Cureus 2016; 8:e546.
  34. Laurent C, Delas A, Gaulard P, et al. Breast implant-associated anaplastic large cell lymphoma: two distinct clinicopathological variants with different outcomes. Ann Oncol 2016; 27:306.
  35. Rupani A, Frame JD, Kamel D. Lymphomas Associated with Breast Implants: A Review of the Literature. Aesthet Surg J 2015; 35:533.
  36. Clemens MW, Miranda RN. Commentary on: Lymphomas Associated With Breast Implants: A Review of the Literature. Aesthet Surg J 2015; 35:545.
  37. Hwang MJ, Brown H, Murrin R, et al. Breast implant-associated anaplastic large cell lymphoma: a case report and literature review. Aesthetic Plast Surg 2015; 39:391.
  38. Hall-Findlay EJ. Discussion: Breast implant-associated anaplastic large cell lymphoma: a systematic review. Plast Reconstr Surg 2015; 135:721.
  39. Gidengil CA, Predmore Z, Mattke S, et al. Breast implant-associated anaplastic large cell lymphoma: a systematic review. Plast Reconstr Surg 2015; 135:713.
  40. Alekseeva IG, Lapina GP, Tulovskaia ZD, Izmaĭlova VN. [Structure formation in interphase adsorption layers of lysozyme at liquid boundaries]. Biofizika 1975; 20:566.
  41. Smith TJ, Ramsaroop R. Breast implant related anaplastic large cell lymphoma presenting as late onset peri-implant effusion. Breast 2012; 21:102.
  42. Gaudet G, Friedberg JW, Weng A, et al. Breast lymphoma associated with breast implants: two case-reports and a review of the literature. Leuk Lymphoma 2002; 43:115.
  43. Alobeid B, Sevilla DW, El-Tamer MB, et al. Aggressive presentation of breast implant-associated ALK-1 negative anaplastic large cell lymphoma with bilateral axillary lymph node involvement. Leuk Lymphoma 2009; 50:831.
  44. Li S, Lee AK. Silicone implant and primary breast ALK1-negative anaplastic large cell lymphoma, fact or fiction? Int J Clin Exp Pathol 2009; 3:117.
  45. Farkash EA, Ferry JA, Harris NL, et al. Rare lymphoid malignancies of the breast: a report of two cases illustrating potential diagnostic pitfalls. J Hematop 2009; 2:237.
  46. Bishara MR, Ross C, Sur M. Primary anaplastic large cell lymphoma of the breast arising in reconstruction mammoplasty capsule of saline filled breast implant after radical mastectomy for breast cancer: an unusual case presentation. Diagn Pathol 2009; 4:11.
  47. Lazzeri D, Agostini T, Giannotti G, et al. Null-type anaplastic lymphoma kinase-negative anaplastic large cell lymphoma arising in a silicone breast implant capsule. Plast Reconstr Surg 2011; 127:159e.
  48. Talwalkar SS, Miranda RN, Valbuena JR, et al. Lymphomas involving the breast: a study of 106 cases comparing localized and disseminated neoplasms. Am J Surg Pathol 2008; 32:1299.
  49. Lechner MG, Lade S, Liebertz DJ, et al. Breast implant-associated, ALK-negative, T-cell, anaplastic, large-cell lymphoma: establishment and characterization of a model cell line (TLBR-1) for this newly emerging clinical entity. Cancer 2011; 117:1478.
  50. Carty MJ, Pribaz JJ, Antin JH, et al. A patient death attributable to implant-related primary anaplastic large cell lymphoma of the breast. Plast Reconstr Surg 2011; 128:112e.
  51. Aladily TN, Medeiros LJ, Amin MB, et al. Anaplastic large cell lymphoma associated with breast implants: a report of 13 cases. Am J Surg Pathol 2012; 36:1000.
  52. Lazzeri D, Zhang YX, Huemer GM, et al. Capsular contracture as a further presenting symptom of implant-related anaplastic large cell lymphoma. Am J Surg Pathol 2012; 36:1735.
  53. Bautista-Quach MA, Nademanee A, Weisenburger DD, et al. Implant-associated primary anaplastic large-cell lymphoma with simultaneous involvement of bilateral breast capsules. Clin Breast Cancer 2013; 13:492.
  54. Farace F, Bulla A, Marongiu F, et al. Anaplastic large cell lymphoma of the breast arising around mammary implant capsule: an Italian report. Aesthetic Plast Surg 2013; 37:567.
  55. Ivaldi C, Perchenet AS, Jallut Y, Casanova D. [Two cases of lymphoma in an implant capsule: A difficult diagnosis, an unknown pathology]. Ann Chir Plast Esthet 2013; 58:688.
  56. Parthasarathy M, Orrell J, Mortimer C, Ball L. Chemotherapy-resistant breast implant-associated anaplastic large cell lymphoma. BMJ Case Rep 2013; 2013.
  57. Thompson PA, Prince HM. Breast implant-associated anaplastic large cell lymphoma: a systematic review of the literature and mini-meta analysis. Curr Hematol Malig Rep 2013; 8:196.
  58. Wong AK, Lopategui J, Clancy S, et al. Anaplastic large cell lymphoma associated with a breast implant capsule: a case report and review of the literature. Am J Surg Pathol 2008; 32:1265.
  59. Taylor KO, Webster HR, Prince HM. Anaplastic large cell lymphoma and breast implants: five Australian cases. Plast Reconstr Surg 2012; 129:610e.
  60. Sørensen K, Murphy J, Lennard A, et al. Anaplastic large cell lymphoma in a reconstructed breast using a silicone implant: a UK case report. J Plast Reconstr Aesthet Surg 2014; 67:561.
  61. Newman MK, Zemmel NJ, Bandak AZ, Kaplan BJ. Primary breast lymphoma in a patient with silicone breast implants: a case report and review of the literature. J Plast Reconstr Aesthet Surg 2008; 61:822.
  62. Miranda RN, Aladily TN, Prince HM, et al. Breast implant-associated anaplastic large-cell lymphoma: long-term follow-up of 60 patients. J Clin Oncol 2014; 32:114.
  63. Hart AM, Lechowicz MJ, Peters KK, et al. Breast Implant-Associated Anaplastic Large Cell Lymphoma: Report of 2 Cases and Review of the Literature. Aesthet Surg J 2014; 34:884.
  64. Palraj B, Paturi A, Stone RG, et al. Soft tissue anaplastic large T-cell lymphoma associated with a metallic orthopedic implant: case report and review of the current literature. J Foot Ankle Surg 2010; 49:561.
  65. Coleman MP. Cancer risk from orthopedic prostheses. Ann Clin Lab Sci 1996; 26:139.
  66. Yoon HJ, Choe JY, Jeon YK. Mucosal CD30-Positive T-Cell Lymphoproliferative Disorder Arising in the Oral Cavity Following Dental Implants: Report of the First Case. Int J Surg Pathol 2015; 23:656.
  67. Kellogg BC, Hiro ME, Payne WG. Implant-associated anaplastic large cell lymphoma: beyond breast prostheses. Ann Plast Surg 2014; 73:461.
  68. Anaplastic Large Cell Lymphoma (ALCL) in Women with Breast Implants: Preliminary FDA Findings and Analyses. Center for Devices and Radiological Health US Food and Drug Administration 2011. www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm239996.htm (Accessed on August 16, 2011).
  69. http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm239995.htm (Accessed on July 06, 2016).
  70. Clemens MW, Medeiros LJ, Butler CE, et al. Complete Surgical Excision Is Essential for the Management of Patients With Breast Implant-Associated Anaplastic Large-Cell Lymphoma. J Clin Oncol 2016; 34:160.
  71. Thompson PA, Lade S, Webster H, et al. Effusion-associated anaplastic large cell lymphoma of the breast: time for it to be defined as a distinct clinico-pathological entity. Haematologica 2010; 95:1977.
  72. Roden AC, Macon WR, Keeney GL, et al. Seroma-associated primary anaplastic large-cell lymphoma adjacent to breast implants: an indolent T-cell lymphoproliferative disorder. Mod Pathol 2008; 21:455.
  73. Granados R, Lumbreras EM, Delgado M, et al. Cytological Diagnosis of Bilateral Breast Implant-Associated Lymphoma of the ALK-Negative Anaplastic Large-Cell Type. Clinical Implications of Peri-Implant Breast Seroma Cytological Reporting. Diagn Cytopathol 2016; 44:623.
  74. Alcalá R, Llombart B, Lavernia J, et al. Skin involvement as the first manifestation of breast implant-associated anaplastic large cell lymphoma. J Cutan Pathol 2016; 43:602.
  75. Orofino N, Guidotti F, Cattaneo D, et al. Marked eosinophilia as initial presentation of breast implant-associated anaplastic large cell lymphoma. Leuk Lymphoma 2016; 57:2712.
  76. Clemens M, July 2015, personal communication.
  77. Tardío JC, Granados R. Axillary Lymphadenopathy: An Outstanding Presentation for Breast Implant-Associated ALK-Negative Anaplastic Large Cell Lymphoma. Int J Surg Pathol 2015; 23:424.
  78. Kadin ME, Deva A, Xu H, et al. Biomarkers Provide Clues to Early Events in the Pathogenesis of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Aesthet Surg J 2016; 36:773.
  79. Swerdlow SH, Campo E, Harris NL, et al. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, Fourth Edition, IARC Press, Lyon 2008.
  80. Taylor CR, Siddiqi IN, Brody GS. Anaplastic large cell lymphoma occurring in association with breast implants: review of pathologic and immunohistochemical features in 103 cases. Appl Immunohistochem Mol Morphol 2013; 21:13.
  81. van Dorp M, T'Kindt J, Mertens M, Colpaert SD. Novel Technique for Sampling of Breast Implant-associated Seroma in Anaplastic Large Cell Lymphoma. Plast Reconstr Surg Glob Open 2016; 4:e688.
  82. Wu D, Allen CT, Fromm JR. Flow cytometry of ALK-negative anaplastic large cell lymphoma of breast implant-associated effusion and capsular tissue. Cytometry B Clin Cytom 2015; 88:58.
  83. Wu D, Allen CT, Fromm JR. Flow cytometry of ALK-negative anaplastic large cell lymphoma of breast implant-associated effusion and capsular tissue. Cytometry B Clin Cytom 2014.
  84. Talagas M, Uguen A, Charles-Petillon F, et al. Breast implant-associated anaplastic large-cell lymphoma can be a diagnostic challenge for pathologists. Acta Cytol 2014; 58:103.
  85. Kim B, Predmore ZS, Mattke S, et al. Breast Implant-associated Anaplastic Large Cell Lymphoma: Updated Results from a Structured Expert Consultation Process. Plast Reconstr Surg Glob Open 2015; 3:e296.
  86. Adrada BE, Miranda RN, Rauch GM, et al. Breast implant-associated anaplastic large cell lymphoma: sensitivity, specificity, and findings of imaging studies in 44 patients. Breast Cancer Res Treat 2014; 147:1.
  87. Acevedo-Báñez I, García-Gomez FJ, Jiménez-Granero P, et al. 18F-FDG-PET/CT in implant-associated anaplastic large cell lymphoma of the breast. Br J Haematol 2015; 169:1.
  88. Mulligan C, Salisbury E, Tschuchnigg M, et al. ALK1-Negative Anaplastic Large Cell Lymphoma of the Breast from a Nonprosthesis Cyst. Plast Reconstr Surg Glob Open 2014; 2:e238.
  89. Sathyanarayanan V, Lokesh KN, Lakshmaiah KC, et al. Anaplastic lymphoma kinase (ALK) positive anaplastic large cell lymphoma (ALCL) of breast in a patient without a breast implant. Ann Saudi Med 2014; 34:551.
  90. Cao YB, Wang SS, Huang HQ, et al. [Primary breast lymphoma--a report of 27 cases with literature review]. Ai Zheng 2007; 26:84.
  91. Gholam D, Bibeau F, El Weshi A, et al. Primary breast lymphoma. Leuk Lymphoma 2003; 44:1173.
  92. Cheah CY, Campbell BA, Seymour JF. Primary breast lymphoma. Cancer Treat Rev 2014; 40:900.
  93. Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol 2014; 32:3059.
  94. Barrington SF, Mikhaeel NG, Kostakoglu L, et al. Role of imaging in the staging and response assessment of lymphoma: consensus of the International Conference on Malignant Lymphomas Imaging Working Group. J Clin Oncol 2014; 32:3048.
  95. Sobin LH, Gospadarowicz MK, Wittekind C. TNM Classification of Malignant Tumours, 7th ed, Wiley-Blackwell, Hoboken, NJ 2009.
  96. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Non-Hodgkin's Lymphomas. January 25, 2012. https://www.nccn.org/professionals/physician_gls/f_guidelines.asp#nhl (Accessed on June 17, 2016).
  97. Institut National du Cancer. Agence Nationale de Sécurité du Médicament. Breast Implant Associated Anaplastic Large Cell Lymphoma: Expert Opinion, February 1, 2015. http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjosoHA6q_NAhXFFh4KHVnJAsUQFggeMAA&url=http%3A%2F%2Fwww.e-cancer.fr%2Fcontent%2Fdownload%2F119635%2F1429833%2Ffile%2FBreast%2520implant-associated%2520anaplastic%2520large%2520cell%2520lymphomas.pdf&usg=AFQjCNHG0_jv7Vi1Pc8HKDqIWiOEiX5Y2w (Accessed on June 17, 2016).
  98. Vaklavas C, Forero-Torres A. Safety and efficacy of brentuximab vedotin in patients with Hodgkin lymphoma or systemic anaplastic large cell lymphoma. Ther Adv Hematol 2012; 3:209.
  99. Zinzani PL, Sasse S, Radford J, et al. Brentuximab vedotin in relapsed/refractory Hodgkin lymphoma: An updated review of published data from the named patient program. Crit Rev Oncol Hematol 2016; 104:65.
  100. Fabbri A, Cencini E, Gozzetti A, et al. Therapeutic Use of Brentuximab Vedotin In Cd30+ Hematologic Malignancies. Anticancer Agents Med Chem 2016.
  101. Estes CF, Zhang D, Reyes R, et al. Locally advanced breast implant-associated anaplastic large-cell lymphoma: a case report of successful treatment with radiation and chemotherapy. Front Oncol 2015; 5:26.
  102. Santanelli di Pompeo F, Laporta R, Sorotos M, et al. Breast Implant-Associated Anaplastic Large Cell Lymphoma: Proposal for a Monitoring Protocol. Plast Reconstr Surg 2015; 136:144e.
  103. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm241101.htm.
  104. http://www.plasticsurgery.org/ (Accessed on July 25, 2016).
  105. Clemens MW, Miranda RN, Butler CE. Breast Implant Informed Consent Should Include the Risk of Anaplastic Large Cell Lymphoma. Plast Reconstr Surg 2016; 137:1117.
  106. Chung KC, Malay S, Shauver MJ, Kim HM. Economic analysis of screening strategies for rupture of silicone gel breast implants. Plast Reconstr Surg 2012; 130:225.
  107. http://www.thepsf.org/research/clinical-impact/profile-investigating-breast-implant-associated-alcl.htm (Accessed on June 17, 2016).