BIA-ALCL and BIA-SCC: Updates on Clinical Features and Genetic Mutations for Latest Recommendations

BIA-ALCL and BIA-SCC are two distinct cancers arising from the breast implant capsule, with a low estimated incidence and prevalence [5,6]. The genetic mutations associated with these tumors are a key subject of interest and investigation.

Pathogenesis and Genetic Features

Experimental studies conducted in mouse models have elucidated that the implantation of alloplastic materials serves as a predisposing factor for tumorigenesis, particularly with regard to sarcomas [18]. As concerns breast implants, initial concerns about the risk of breast cancer development have been extensively disproved. Nonetheless, in recent decades, an increasing number of medical reports have shifted attention to the occurrence, although rare, of tumors arising from the breast implant capsule [19]. The implantation of devices such as breast tissue expanders or implants evokes a foreign body reaction characterized by the recruitment of immune system mediators, including macrophages and T-cells, and the formation of a fibrous tissue capsule, which envelops and isolates the implanted foreign body. Overall, this process is a benign physiological immune response led by the activation of an inflammatory cascade [20]. In the early phase, the peri-implant fibrous capsule is primarily made up of granulation tissue, which matures and is gradually replaced by collagen type I. Despite the periprosthetic tissue surrounding the implant, the chronic immune response to the implant persists, and the longer it does so, the higher the chance of DNA modification (Figure 1). Therefore, it could be inferred that the greatest risk factor for BIA-ALCL and BIA-SCC is inflammation, or more specifically, chronic inflammation. Breast cancer and a history of non-breast cancer neoplasia are not considered independent risk factors [21]. In fact, reports of these neoplasia have been found in association with both cosmetic and reconstructive breast implant capsules [22]. For BIA-ALCL, inflammatory stimuli may cause DNA modifications, which in turn triggers the activation and dysregulation of T-cells; for BIA-SCC, this may include the metaplasia of epithelial cells.

The full article here: https://www.mdpi.com/1648-9144/60/5/793