Annals of surgical oncology · 2026
BRCA Mutation Carriers and Breast Implant-Associated Anaplastic Large-Cell Lymphoma: Accumulating Evidence, Proposed Mechanism, and Implications for Reconstructive Planning and Follow-Up.
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Shachar Yair
Аннотация
BACKGROUND: Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is an uncommon cluster of differentiation (CD)-30-positive T-cell lymphoma arising in the peri-implant capsule that was recognized as a definitive entity by the World Health Organization (WHO) in its 2022 fifth edition. Although historically framed as a device complication of textured implant surfaces, recent evidence suggests that germline mutations in BRCA1, BRCA2, and TP53 confer independent host-level susceptibility. These findings have yet to be synthesized for the surgical oncology audience.
METHODS: This was a narrative review adhering to Scale for the Assessment of Narrative Review Articles (SANRA) criteria. PubMed and MEDLINE were searched from January 2000 through March 2026. Evidence was ranked using the 2011 Oxford Centre for Evidence-Based Medicine levels of evidence.
DISCUSSION: Four evidence streams spanning 15 years have consistently associated germline BRCA1/2 and TP53 mutations with elevated BIA-ALCL risk. The 2025 Memorial Sloan Kettering Cancer Center prospective cohort reported a 16-fold increased age-adjusted risk in BRCA1/2 carriers (95% confidence interval 3.6-76.1). Compressed disease latency has been observed in mutation carriers. Overall, these reports suggest a gene-environment interaction model where impaired homologous recombination repair lowers the threshold for clonal T-lymphocyte expansion in the chronic inflammatory peri-implant microenvironment. Autologous reconstruction eliminates the BIA-ALCL risk. Thus, both autologous and smooth implant-based reconstruction should be explicitly discussed with BRCA carriers, and textured devices should be avoided if implant-based reconstruction is chosen. Surveillance strategies, including explicit documentation, earlier investigation thresholds, and structured long-term handoff, are recommended.
CONCLUSIONS: The evidence is observational and not yet sufficient for prescriptive guidelines but is consistent, biologically coherent, and of sufficient magnitude to warrant a measured adjustment in reconstructive counseling, implant selection, and follow-up in BRCA mutation carriers.
METHODS: This was a narrative review adhering to Scale for the Assessment of Narrative Review Articles (SANRA) criteria. PubMed and MEDLINE were searched from January 2000 through March 2026. Evidence was ranked using the 2011 Oxford Centre for Evidence-Based Medicine levels of evidence.
DISCUSSION: Four evidence streams spanning 15 years have consistently associated germline BRCA1/2 and TP53 mutations with elevated BIA-ALCL risk. The 2025 Memorial Sloan Kettering Cancer Center prospective cohort reported a 16-fold increased age-adjusted risk in BRCA1/2 carriers (95% confidence interval 3.6-76.1). Compressed disease latency has been observed in mutation carriers. Overall, these reports suggest a gene-environment interaction model where impaired homologous recombination repair lowers the threshold for clonal T-lymphocyte expansion in the chronic inflammatory peri-implant microenvironment. Autologous reconstruction eliminates the BIA-ALCL risk. Thus, both autologous and smooth implant-based reconstruction should be explicitly discussed with BRCA carriers, and textured devices should be avoided if implant-based reconstruction is chosen. Surveillance strategies, including explicit documentation, earlier investigation thresholds, and structured long-term handoff, are recommended.
CONCLUSIONS: The evidence is observational and not yet sufficient for prescriptive guidelines but is consistent, biologically coherent, and of sufficient magnitude to warrant a measured adjustment in reconstructive counseling, implant selection, and follow-up in BRCA mutation carriers.