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CC BY 4.0 · Arch Plast Surg 2025; 52(01): 011-020
DOI: 10.1055/a-2427-2066
Breast/Trunk
Case Report

Neoadjuvant Immunotherapy and De-escalation of Surgery in Locally Advanced Breast Implant-associated Anaplastic Large Cell Lymphoma

Marzia Salgarello 
1   Department of Plastic Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
,
Jaroslaw Krupa 
2   Department of Breast Surgery, University Hospitals of Leicester NHS Trust, Leicester, Leicester, United Kingdom of Great Britain and Northern Ireland
,
Rebecca Allchin
2   Department of Breast Surgery, University Hospitals of Leicester NHS Trust, Leicester, Leicester, United Kingdom of Great Britain and Northern Ireland
,
Simon Pilgrim 
3   Department of Haematology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom of Great Britain and Northern Ireland
,
Fiona Miall 
3   Department of Haematology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom of Great Britain and Northern Ireland
,
Arianna Di Napoli 
4   Department of Clinical and Molecular Medicine, Sapienza University, Sant'Andrea University Hospital, Rome, Italy
,
Maurizio Martelli 
5   Group of Experts on BIA-ALCL, Istituto Superiore di Sanità, Roma, Lazio, Italy
6   Department of Translational and Precision Medicine, Umberto I Policlinico di Roma, Roma, Lazio, Italy
,
Giulio Tarantino 
7   Department of Plastic, Reconstructive, and Esthetic surgery, Università Cattolica del Sacro Cuore, Rome, Italy
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Abstract

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare form of non-Hodgkin T-cell lymphoma diagnosed in patients with a history of breast implants. Most patients develop a periprosthetic effusion at early stages of disease while less common presentations include a palpable mass, severe capsular contracture, lymphadenopathy, or cutaneous erythema. Due to the complex nature of this disease, a multidisciplinary approach is necessary for optimal management, particularly in locally advanced disease or inoperable patients. We present the successful use of neoadjuvant therapeutic protocols in two cases of locally advanced BIA-ALCL. The first case was a 52-year-old patient with a left breast mass-like stage III disease who underwent combined targeted immunotherapy and chemotherapy (brentuximab vedotin [BV]–cyclophosphamide, doxorubicin, prednisone [CHP]). Following a complete radiological and metabolic response, the patient underwent bilateral implant removal, right total intact capsulectomy, left en bloc capsulectomy, and skin resection from the left inframammary fold in continuity with the capsule. The second case was a 65-year-old patient with right breast swelling and mass-like stage IIA disease who received targeted immunotherapy, BV. Following a complete metabolic response, she underwent bilateral implant removal and en bloc capsulectomy. A literature review and the reported cases suggest the effectiveness of targeted immunotherapy as monotherapy or in combination with chemotherapy in locally advanced BIA-ALCL in disease downstaging, surgical de-escalation, reduction of significant postoperative complications, and an acceptable tolerance profile. Although surgery is an essential part of treatment, the timing and type of intervention should be carefully planned, especially when primary, radical resection is uncertain.

Keywords

brentuximab vedotin - breast implant-associated anaplastic large cell lymphoma - breast implant - neoadjuvant therapy - capsulectomy

Authors' Contributions

M.S: conceptualized and designed the study. G.T. and J.K conducted the literature search, study screening, data extraction, and quality assessment. M.S., J.K. and G.T. contributed to data interpretation. J.K. and G.T. drafted the initial manuscript. M.S., J.K. and G.T. critically reviewed and revised the manuscript for important intellectual content. M.S. provided study supervision. M.S., J.K., A.R., P.S., M.F., A.D.N., M.M. and G.T. approved the final manuscript as submitted and agree to be accountable for all aspects of the work.


Ethical Approval

Exemption from ethics approval.


Patient Consent

Both patients provided written informed consent for the publication and use of their images.




Publication History

Received: 02 October 2023

Accepted: 23 September 2024

Accepted Manuscript online:
30 September 2024

Article published online:
24 December 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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