Adams WP, et al. - Successful minimization in the occurrence of capsular contracture by using techniques to reduce the number of bacteria around implants, specifically, the 14-point plan led authors to make and test a hypothesis that a similar effect could be seen in reducing the risk of breast implant–associated anaplastic large-cell lymphoma (ALCL). Findings revealed the role of a sustained T-cell response to implant bacteria/biofilm in the development of breast implant–associated ALCL. Using the principles of the 14-point plan to minimize bacterial load at the time of surgery, the development and subsequent sequelae of capsular contracture and breast implant–associated ALCL could be reduced, especially with higher-risk macrotextured implants.

Methods

• Using pooled data from eight plastic surgeons authors assessed the use of macrotextured breast implants (Biocell and polyurethane) and known cases of breast implant–associated ALCL.
• They also analyzed surgeon adherence to the 14-point plan.

Results

• Data suggested that total 42,035 Biocell implants were placed in 21,650 patients; mean follow-up time was 11.7 years (range, 1 to 14 years).
• 704 polyurethane implants were used; mean follow-up time was 8.0 years (range, 1 to 20 years).
• The overall capsular contracture rate of 2.2 percent was observed.
• Authors noticed no cases of implant–associated ALCL.
• All 13 perioperative components of the 14-point plan were routinely performed by all surgeons; two surgeons did not routinely prescribe prophylaxis for subsequent unrelated procedures.