Mankowski Peter, Carr Matthew, Cherukupalli Abhiram, Bovill Esta, Lennox Peter, Brown Mitchell H, Carr Nicholas
University of British Columbia Department of Surgery, Division of Plastic Surgery, Vancouver General Hospital, Vancouver, BC, Canada.
Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Aesthet Surg J. 2022 Dec 14;42(12):1408-1413. doi: 10.1093/asj/sjac158.
The recall of Allergan Biocell (Irvine, CA) devices due to the association between anaplastic large cell lymphoma (ALCL) and macrotextured breast implants means that plastic surgeons are faced with the challenge of caring for patients with these implants in situ. Cosmetic and reconstructive surgeons have been contacting affected patients to encourage them to follow up and discuss the most appropriate risk-reduction strategies.
The aim of this study was to evaluate patient concerns about the risk of breast implant-associated ALCL (BIA-ALCL) and to compare management differences between cosmetic and reconstructive patients.
A retrospective review was performed of 432 patients with macrotextured implants who presented to clinic after being contacted (121 reconstructive and 311 cosmetic). These records were analyzed for their presenting concerns, surgery wait times, and management plans. Statistical analysis was performed to compare the cohorts, and odds ratios (ORs) were computed to determine the association between patient concerns and their choice of management.
After consultation, 59.5% of the reconstructive cohort and 49.5% of the cosmetic cohort scheduled implant removal or exchange. The reconstructive population had a higher rate of ALCL concern (62.7%); however, both cohorts had a significant OR, demonstrating an expressed fear of ALCL likely contributed to their subsequent clinical management (OR cosmetic, 1.66; OR reconstructive, 2.17).
Although the risk of ALCL appears to be more concerning to the reconstructive population, both cohorts were equally motivated to have their implants removed. Informing patients about their ALCL risk is crucial to ensure a patient-supported risk reduction plan.
由于间变性大细胞淋巴瘤（ALCL）与大纹理乳房植入物之间的关联，艾尔建生物细胞（加利福尼亚州欧文市）设备被召回，这意味着整形外科医生面临着护理原位植入这些植入物患者的挑战。美容和重建外科医生一直在联系受影响的患者，鼓励他们进行随访并讨论最合适的降低风险策略。
本研究的目的是评估患者对乳房植入物相关ALCL（BIA-ALCL）风险的担忧，并比较美容患者和重建患者在管理上的差异。
对432例大纹理植入物患者进行回顾性研究，这些患者在接到通知后前来就诊（121例重建患者和311例美容患者）。分析这些记录中的就诊担忧、手术等待时间和管理计划。进行统计分析以比较队列，并计算优势比（OR）以确定患者担忧与其管理选择之间的关联。
咨询后，59.5%的重建队列患者和49.5%的美容队列患者安排了植入物取出或更换。重建人群对ALCL的担忧率更高（62.7%）；然而，两个队列的OR值都很高，表明对ALCL的明显恐惧可能导致了他们随后的临床管理（美容队列OR值为1.66；重建队列OR值为2.17）。
尽管重建人群似乎更担心ALCL风险，但两个队列同样有动力取出植入物。告知患者其ALCL风险对于确保患者支持的降低风险计划至关重要。
