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Breast implants and anaplastic large cell lymphoma

BMJ 2018; 363 doi: (Published 30 November 2018) Cite this as: BMJ 2018;363:k5054
  1. J Michael Dixon, professor1,
  2. Mark Clemens, associate professor2
  1. 1Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK
  2. 2MD Anderson Cancer Center, University of Texas, Texas, USA
  1. Correspondence to: J M Dixon jmd{at}

An emerging safety concern for textured implants

Anaplastic large cell lymphoma (ALCL) has been reported in association with a tibial implant, dental implant, chest injection port, gluteal implant, shoulder repair, and a gastric band placement.1 It is, however most commonly associated with textured surface breast prostheses used for breast augmentation or reconstruction.2 Breast implant associated ALCL is a type of T cell lymphoma that is mainly indolent. So far, 626 cases and 17 deaths have been reported worldwide.1234 Early recognition, prompt diagnosis, and appropriate treatment are the cornerstones of current care.3

There are two main types of breast implants: smooth surfaced and textured. Texturing is required for anatomically shaped implants to stop them rotating. No confirmed cases of ALCL have been reported with round, smooth surface prostheses. The lymphoma seems exclusively associated with textured prostheses, and the risk is highest for more robustly textured or polyurethane covered implants (range 1:1000 to 1:10 000 implants).45678

In a prospective study of 17 656 patients with 31 985 anatomical textured prostheses, there were eight …

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