Breast implant-associated anaplastic large cell lymphoma in the post-mastectomy setting: Clinical and therapeutic implications

We report a case of breast implant-associated anaplastic large cell lymphoma in a 70-year old woman, who 21 years previously had undergone bilateral breast augmentation with textured silicone implants. Eleven years later, she had bilateral implant removal with possible implant leak and presence of ‘atypical cells’ in the seroma. She then opted for prophylactic bilateral mastectomy in view of her strong family history of breast cancer and underwent reconstruction with subcutaneous gel implants. Eight months later, the patient noted right breast swelling and peri-implant effusion. The cytology was suspicious for lymphoma. Bilateral implant removal and capsulectomy was performed and a breast implant-associated anaplastic large cell lymphoma was diagnosed. Due to the lack of surrounding breast tissue after mastectomy, it was not possible to thoroughly sample or evaluate breast parenchymal involvement by the lymphoma, an important consideration in determining aggressivity. The decision was made to initiate Brentuximab vedotin therapy.