New algorithm guides plastic surgeons in managing women with ALCL after breast augmentation

In the wake of a recent FDA statement linking breast implants to a rare cancer called anaplastic large cell lymphoma (ALCL), a newly updated algorithm provides plastic surgeons with guidance in managing women with breast lumps or swelling after breast augmentation. The algorithm appears in an article published on the website of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The article will be published in the June 2011 print issue of the journal.

The algorithm "specifically addresses additional diagnosis and management alternatives for management of seroma in breast augmentation patients that may relate to lymphoproliferative disorders or ALCL," writes Dr. John B. Tebbetts, a Dallas plastic surgeon.

Stepwise Approach Guides Decision-Making by Surgeons and Patients
Dr. Tebbetts presents an update of a previous algorithm on the diagnosis and management of seromas after breast augmentation surgery. Seromas are collections of wound fluid (serum) that can develop after various types of surgery. The update was prompted by reports of ALCL and other lymphoproliferative disorders developing in women who have undergone breast augmentation. Based on these reports, the FDA has issued a statement warning of "a very small, but increased risk" of ALCL in women with breast implants.

The link to ALCL poses a challenge for plastic surgeons, because ALCL may first appear as a painful lump or swelling in the operated breast. That's very similar to the symptoms of seroma—a much more common, but less serious, problem after breast augmentation. Since the FDA statement, plastic surgeons and their patients are seeking a rational approach to diagnosis and treatment of lumps or swelling associated with breast implants.

In developing the updated algorithm, Dr. Tebbetts' goal was to "increase awareness and vigilance" for the possibility of ALCL when evaluating fluid collections occurring six months or longer after breast augmentation. The algorithm includes "a sequential set of alternatives" for surgeons to discuss with patients, prioritized to lead to an accurate diagnosis of ALCL if it's present—and to avoid unnecessary reoperation if it's not.

The algorithm can serve as a useful framework for discussion, helping patients to make an informed decision regarding their diagnostic and treatment options. For each management alternative—from diagnostic needle aspiration, to various options for reoperation, to doing nothing—the potential advantages and risks/tradeoffs are listed.

The algorithm will be further updated as more evidence comes to light. Ongoing initiatives by the FDA and ASPS, among others, will help to define the true relationship between breast augmentation and ALCL—if any. Until more definitive information becomes available, Dr. Tebbetts believes the updated algorithm will provide a valuable "interim summary of alternatives" for plastic surgeons and other health care professionals involved in the care of women with breast implants.