Secondary intact capsulectomy with seroma without implant: revision of an incomplete treatment of BIA-ALCL – a case report

Background: Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a haematological malignancy which may occur in patients with textured breast implant history. While typically diagnosed at an early stage with good prognosis, it may present with local residual disease due to incomplete surgical excision. Case presentation: We describe the case of a 42 year-old woman with a history of bilateral breast augmentation for cosmetic purposes 21 years prior, who developed recurring seroma of the left side. She sought help from her first surgeon who performed 2 breast implant exchange procedures placing textured devices and finally a bilateral breast implant removal over the course of two decades. The patient did not receive capsulectomies in the previous implant exchanges, and received sampling from the anterior capsule in the last procedure, where BIA-ALCL was diagnosed on the left side. She was referred to a tertiary cancer center where preoperative workup confirmed presence of local residual disease. Following multidisciplinary team management, she underwent revision of en-bloc capsulectomy of the left side without need for additional treatments. Post-operative course was uneventful with no signs of local recurrences at 18 months follow-up. Conclusion: Residual disease in BIA-ALCL may be caused not only by tumor characteristics or extent, but also by misdiagnosis or late diagnosis. This case highlights the critical importance of thorough surgical excision in BIA-ALCL. The existence of guidelines and clinical practice recommendations direct surgeons on how to appropriately recognize and manage symptomatic patients in order to treat suspicious cases in a timely manner.