Anaplastic large-cell lymphoma risk after reconstructive surgery is extremely low, study finds

The incidence of a rare cancer, anaplastic large-cell lymphoma (ALCL), has surged in recent years, possibly because of the growing use of textured breast implants. Considering this trend, some breast cancer patients who undergo mastectomy may wonder if the benefits of getting reconstructive implants are worth the risk of developing a second cancer.

A new Columbia study should make many women's decisions easier. The study found that the risk of developing ALCL after reconstructive surgery is extremely low: Each year, about 12 cases are expected to occur per 1 million women who've had reconstructive surgery.

The risk of developing ALCL is actually much lower than the risk of experiencing a relapse of breast cancer. Based on our findings, we do not believe that women should be dissuaded from having implant-based breast reconstruction after mastectomy solely due to the risk of ALCL."

Connor J. Kinslow, MD, lead author, resident in radiation oncology, Columbia University Vagelos College of Physicians and Surgeons

The new study was designed to provide women with accurate information about risk and is the first to look at rates of ALCL in breast cancer survivors who've had breast implants after mastectomy.

The researchers used a national cancer registry to identify 57,000 women who had undergone mastectomy with implant reconstruction for breast cancer or ductal carcinoma in situ (an early, noninvasive stage of breast cancer) between 2000 and 2018. The median follow-up time was seven years, and roughly 16,000 women were followed for at least 10 years.

Though the study found that women who have had post-mastectomy breast implants do have a higher risk of ALCL than women in general (each year, 0.3 cases are expected per million in the general population), "it should be noted that ALCL is a rare cancer," says study leader David Horowitz, MD, assistant professor of radiation oncology at Columbia University Vagelos College of Physicians and Surgeons. "Among the 57,000 women in the study, only five cases of ALCL were diagnosed over the combined 421,000 years of follow-up."

"Women who have had one cancer are understandably nervous about having a second," Kinslow says. "But that shouldn't necessarily put them off from having reconstructive implants. For many women, breast reconstruction after mastectomy is extremely important to quality of life, and women should feel comfortable going ahead with implants without adding to the psychological burdens that come with a breast cancer diagnosis."