Background:Breast implant-associated anaplastic large cell lymphoma is a rare but significant complication of breast implants, with persistent uncertainties regarding its etiology, incidence, and optimal management strategies, particularly regarding prophylactic explantation in asymptomatic patients with textured implants. This study aims to assess current opinions and practices related to breast implant-associated anaplastic large cell lymphoma among experts in the field. Methods:A survey was submitted to faculty members (n = 37) and attendees (n = 75) of the 12th International Breast Symposium Düsseldorf in April 2024. The questionnaire captured personal experiences, diagnostic practices, and opinions on the prevention and management of breast implant-associated anaplastic large cell lymphoma. Results:Results indicated that 89% of both faculty members and attendees do not recommend prophylactic explantation of macrotextured implants in asymptomatic patients, aligning with current guidelines. While 62% of faculty members and 68% of attendees believe that the actual incidence of breast implant-associated anaplastic large cell lymphoma is higher than reported due to either underdiagnosis or under-reporting, 97% of faculty members and 96% of attendees routinely inform patients about the risks prior to surgery. Notably, 35% of faculty members and 73% of attendees had not encountered any cases of breast implant-associated anaplastic large cell lymphoma, despite heightened awareness. Conclusions:This study reflects a conservative approach to managing breast implant-associated anaplastic large cell lymphoma among practitioners. The findings underscore the need for standardized implant registries and global reporting protocols to improve risk assessment and patient safety. Further research is essential to clarify the multifactorial etiology of breast implant-associated anaplastic large cell lymphoma and determine the efficacy of prophylactic explantation. Until more definitive evidence is available, individualized patient care with informed discussions and shared decision-making remains paramount.

Background:. Breast augmentation with anatomic implants can achieve a natural look, but over time, implant-related complications can occur. This includes a risk of potential rotation, which can cause a change in breast shape. Reported rates of rotation vary widely (0%–42%). Implant rotation is often detected by physical examination only or as a perioperative finding. Change in breast shape after augmentation requires clinical evaluation. In-office ultrasound allows for detailed assessment of implants for rotation and other complications. Methods:. Women with anatomical breast implants seeking follow-up at the International Breast Implant Check Clinic in Stockholm, Sweden, from April 2020 to July 2022 were included in the study. Using a standardized protocol, subjective symptoms were recorded, and a physical examination followed by an ultrasound assessment was performed by a single board-certified plastic surgeon (M.J.) trained in implant assessment via ultrasound. Rotation was defined as an implant rotated past 30 degrees off the breast midline at 6 o’clock. Results:. The study included 308 women (mean age 40.1, range 20-78) with bilateral anatomical implants. Overall, 40 women (13.0%) reported a change in breast shape; 35 had one or more implant-related complications, including five with rotation on ultrasound. Of the 308 women, 11 (3.6%) had rotations upon physical examination, and an additional 10 cases were identified using ultrasound. Conclusions:. Rotation is a potential complication of anatomical breast implants. However, in this study, change in breast shape was more commonly caused by other implant-related complications. Ultrasound is a valuable tool in evaluating causes of change in breast shape.

Background: The emerging concerns around breast implant-associated anaplastic large cell lymphoma and other chronic inflammatory-related conditions have instigated a wider use of smooth devices.Objectives: The authors aimed to present 6-year data following the introduction of Motiva implants (Establishment Labs Holdings Inc.; Alajuela, Costa Rica) into their previously texture-dominated practice. Additionally, the authors aimed to provide technical recommendations on how to efficiently incorporate these devices into surgical practice and minimize the learning curve.Methods: Data of 1053 primary and secondary breast augmentations conducted between April 2015 and December 2020 in 2 centers (Victoriakliniken in Sweden and the European Institute of Plastic Surgery in Cyprus) were retrospectively evaluated to obtain data on chosen implant characteristics and complications that led to reoperation, prior to and following modifications to surgical practice in 2018.Results: The data from 6 consecutive years demonstrate a low device-related complication rate with Motiva implants. In 2018, following adaptions in surgical practice, the complication rate significantly declined.Conclusions: Motiva implants demonstrate a low complication rate and safety profile for women undergoing primary and secondary breast augmentation procedures. However, to reap the benefits of the antifibrotic profile, technical adaptions and optimal patient planning based on the patient and device characteristics are instrumental. Employing the key principles laid out in this study provides a means for delivering both clinically safe options to patients with aesthetically pleasing long-term results.

Background This analysis presents patient-reported outcomes of breast augmentation procedures performed in Singapore using an inframammary fold incision and the “5 Ps” best practice principles for breast augmentation. These data are the first of their kind in Southeast Asian patients. Methods Through a retrospective chart review, patients who underwent primary breast augmentation with anatomical form-stable silicone gel breast implants using an inframammary fold incision were followed for ≥6 months postoperatively. The BREAST-Q Augmentation Module (scores standardized to 0 [worst] – 100 [best]) and Patient and Observer Scar Assessment Scale (POSAS; 1 [normal skin] to 10 [worst scar imaginable]) were administered. Responses were summarized using descriptive statistics. Patient-reported events were collected. Results Twenty-two Southeast Asian patients (mean age, 35.1 years) completed ≥1 postoperative BREAST-Q and POSAS assessment and were assessed 11 months to 5.5 years postoperatively. The mean postoperative BREAST-Q satisfaction with breasts and psychosocial well-being scores were 69.2 and 84.0, respectively. The mean POSAS score for their overall opinion of the scar was 4.2; the mean scores for all scar characteristics ranged from 1.2 to 4.2. Over 90% of patients (20/22) said that they would recommend the procedure. Patient complaints following surgery included anisomastia (possibly pre-existing; n=2), sensory loss at the nipple (n=2) or around the nipple (n=3), scarring (n=4), and slight capsular contracture (n=1). No patients required reoperation. Conclusions Southeast Asian patients reported high long-term satisfaction scores on the BREAST-Q scale and with their scar characteristics following breast augmentation using an inframammary fold incision, and nearly all said they would recommend this procedure. No reoperations were necessary in patients assessed for up to 5.5 years postoperatively.

INTRODUCTION: Breast implant associated anaplastic large cell lymphoma (BI-ALCL) is a rare type of non-Hodgkin lymphoma occurring in the fluid or capsule adjacent to breast implants. Screening of symptomatic patients requires demonstration of large lymphoid cells with uniform expression of CD30 protein on immunohistochemistry. This study investigates a novel, rapid, office-based, and economic in-situ enzyme-linked immunosorbent assay (ELISA) for screening BI-ALCL patients. METHODS: A commercially available in-situ ELISA was standardized and validated for patients with confirmed BIA-ALCL diagnosis with clinical isolates and a laboratory strain. A panel of five pathologically confirmed BIA-ALCL patients were screened by serum, plasma, and peri-prosthetic effusion specimens and compared against serum, plasma, and non-neoplastic delayed seromas in six healthy control patients. Statistical analysis demonstrated assay consistency and reliability. RESULTS: BIA-ALCL serum specimens and all control specimens were tested at full concentration, 1:100, 1:250, 1:500 and 1:1000 serial dilutions. All BIA-ALCL effusions demonstrated CD30 ELISA detection at full and all serial concentrations. BIA-ALCL plasma specimens were weakly positive at full concentration and no activity with serial dilution. BI-ALCL serum specimens and all control specimens were negative at all concentrations. CONCLUSION: This is the first study to demonstrate a viable alternative to CD30 immunohistochemistry for the screening of BIA-ALCL. A CD30 ELISA represents a novel low-cost screening test, which may be used to screen suspicious aspirations of delayed periprosthetic fluid collections in an office-based setting. This preliminary study demonstrates reliability and efficacy, however prospective testing in an expanded cohort will be required to establish sensitivity and specificity.