Global Adverse Event Reports of Breast Implant-Associated ALCL: An International Review of 40 Government Authority Databases

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I have read with interest the article entitled “Global Adverse Event Reports of Breast Implant-Associated ALCL: An international Review of 40 Government Authority Databases.”1 First, I would like to congratulate the authors for their notable work and thank them for their magnificent effort in creating an international multi-institutional collaboration to acquire accurate information, complete data, and veracious statistics regarding breast implant–associated anaplastic large cell lymphoma (ALCL). It is unquestionable that only through this global collaboration among the implant-fabricant industry, the countries’ health care institutions, and us, the plastic and reconstructive surgeons, will we obtain valuable information to understand breast implant–associated ALCL and offer the best treatment for our patients.
Nonetheless, it has come to my attention that no cases were included from Latin America. I understand this might be because the research criteria included only studies published and reported before 2016. The first case of breast implant–associated ALCL in Latin America was reported in Mexico and published at Cirugía Plástica Ibero-Latinoamericana, the official journal of the Federación Ibero-Latinoamericana de Cirugía Plástica (Iberian–Latin American Federation of Plastic Surgery).2 This journal is actually an international partner of Plastic and Reconstructive Surgery, Global Open. The aforementioned case was presented by Dr. Torres-Rivero et al. Their patient was a 43-year-old woman who underwent augmentation mammaplasty in 2009. The surgical approach was through a periareolar incision, and anatomical, textured, 290-cc implants were placed in a subfascial pocket. According to the authors, the patient had developed mild unspecific symptoms on the right breast 1 year after the primary procedure, which ultimately resolved with oral medications (nonsteroidal antiinflammatory drugs). However, 6 years after the procedure, the patient developed pain and edema in the same breast and, while a magnetic resonance imaging study was being performed, abundant periprosthetic fluid was found. After several ultrasound-guided puncture procedures, the diagnosis was established after the fluid was found positive to CD30+, CD45+, and CD3+. Implant removal and complete capsulectomy were performed. Follow-up continues from both the surgical team and a multidisciplinary team. The patient was of Amerindian descent (mestizo population). Most of the cases reported worldwide, although not fully specified, come from countries were the dominant ethnic background is European and Caucasian. I believe this renders importance, as another line of future research could be to determine the genetic influence in the development of a breast implant–associated ALCL and possibly, a human leukocyte antigen predisposition to the presence of such a neoplasm. This is extrapolated from the well-known association of human leukocyte antigens to specific diseases worldwide.3–5 Recently, there has been an important increase in the awareness of this neoplasm in patients with breast implants in our geographic region. I am certain that both the colleagues and ministries of health from our countries will be more than enthusiastic and willing to participate in a global and firm international collaboration regarding this matter.
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