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
