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Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon and emerging malignancy caused by textured breast implants. The most common patient presentation is delayed seromas, other presentations include breast asymmetry, overlying skin rashes, palpable masses, lymphadenopathy, and capsular contracture. Confirmed diagnoses should receive lymphoma oncology consultation, multidisciplinary evaluation, and PET-CT or CT scan evaluation prior to surgical treatment. Disease confined to the capsule is curable in the majority of patients with complete surgical resection. BIA-ALCL is now recognized as one disease among a spectrum of inflammatory mediated malignancies which include implant-associated squamous cell carcinoma and B cell lymphoma., Competing Interests: Disclosure MD Anderson Cancer Center participates in FDA clinical trials for Abbvie Allergan, Mentor Corporation, and Establishment Labs. All authors report no financial conflicts of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Augmentation mastopexy is generally considered to be one of the most difficult operations in breast surgery. It has an undeserved reputation for high complication rates and unhappy patients. Through careful planning, surgical techniques involving manipulation of the breast while maintaining blood supply and implant cover, and good augmentation technique, the operation can achieve predictable results in most cases with a low complication rate. Techniques to assess and manage the 2 main complications of waterfall deformity and bottoming out are discussed., Competing Interests: Disclosure No relevant disclosures., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The use of prosthetic implants for breast augmentation has become commonplace. Although implants do not increase the risk of conventional mammary carcinoma, they are rarely associated with anaplastic large cell lymphoma. We report 2 cases of breast implant capsule-associated squamous cell carcinoma with poor clinical outcomes. Both patients (56-year-old woman and 81-year-old woman) had long-standing implants (>25 years) and presented with acute unilateral breast enlargement. In both cases, squamous cell carcinoma arose in (focally dysplastic) squamous epithelium-lined breast implant capsules and widely invaded surrounding breast parenchyma or chest wall. Neither patient had evidence of a primary mammary carcinoma or squamous cell carcinoma at any other anatomic site. Within 1 year, one patient developed extensive, treatment-refractory, locoregional soft tissue metastasis, and the second patient developed hepatic and soft tissue metastases and died of disease. There are 2 prior reported cases of implant-associated squamous cell carcinoma in the plastic surgery literature; one provides no pathologic staging or outcome information, and the second case was a capsule-confined squamous cell carcinoma. Together, all 4 cases share notable commonalities: the patients had long-standing breast implants and presented with acute unilateral breast pain and enlargement secondary to tumors arising on the posterior aspect of squamous epithelialized implant capsules. Because of both its rarity and its unusual clinical presentation, implant capsule-associated squamous cell carcinoma may be underrecognized. The aggressive behavior of the tumors in this series underscores the importance of excluding malignancy in patients with long-standing breast implants who present with acute unilateral breast pain and enlargement., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Capsular contracture remains a common and preventable complication of implanted breast prostheses. As our understanding of the pathophysiology continues to develop, it is prudent to reexamine existing beliefs in a contemporary context. This article presents a current summary of clinical and laboratory evidence, expressed as an interaction between potentiating and suppressing factors, and how this understanding can be applied to practice., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Breast implant associated anaplastic large cell lymphoma (BIALCL) is a distinct clinical entity that can present in patients receiving either reconstructive or cosmetic breast implants. Presenting symptoms include onset of a delayed (>1 year after implantation) fluid collection, mass of the capsule, or lymphadenopathy. Treatment has progressed in recent years and most commonly includes implant removal and total resection of the tumor, including capsule, mass, and involved lymph nodes. Further research is warranted to determine potential malignant drivers, disease progression, and optimal treatment strategies in advanced disease., (Copyright © 2015 Elsevier Inc. All rights reserved.)

A 39-year-old female patient was admitted to explore chronic renal failure. Clinical history included silicone breast implants. Clinical examination was normal. Urinalysis revealed tubular proteinuria with Bence-Jones κ protein. Monoclonal immunoglobulin G κ and free monoclonal κ-light chains (LCs) were revealed by serum protein immunoelectrophoresis. Bone marrow aspiration with karyotype analysis and skeletal radiologic survey were normal. Kidney biopsy revealed a peculiar pattern of proximal tubular cells with hypertrophy and clarification initially diagnosed as an osmotic nephrosis. Immunofluorescence study, including immunoglobulin LCs conjugates was normal. Immunoelectron microscopy finally revealed a crystalline LC proximal tubulopathy κ. Our case presents some peculiarities: the absence of hematologic malignancy sign and the young patient's age. The silicone breast implants have been reported to be involved in the generation of monoclonal gammopathy., (Copyright © 2014. Published by Elsevier Inc.)

For more than 40 years capsular contracture has plagued plastic surgery as the most common complication of aesthetic and reconstructive breast surgery. This article reviews the basis for capsular contracture and defines the methods to prevent it and treat it when it occurs. Capsular contracture is most commonly a result of a subclinical colonization of the implant pocket with bacteria. Sound techniques-including precise, atraumatic, bloodless dissection; appropriate triple antibiotic breast pocket irrigation; and minimizing any points of contamination during the procedure-have produced very low capsular contracture rates. Treatment of capsular contracture is most often surgical total capsulectomy with site change when indicated and replacement with a new implant.

Although breast augmentation is a procedure with a high patient satisfaction rate, at some point in time, some patients will need a revision. A better understanding of what leads to revisions is desirable to determine whether the frequency of revisions can be reduced. With that in mind, we reviewed all revisions in a consecutive series of primary breast augmentation patients operated over a 3-year period with a minimum follow-up of 2 years. The overall revision rate was 10%. The primary indications for revision included 4% malposition (bottoming out), 2% capsular contracture, 2% size change, and 2% switch from saline to silicone. Specific case reports are presented in detail to examine the nature of these revisions.

The management of common and uncommon problems following breast augmentation can pose a challenge in some situations. The diversity of these problems is remarkable and different principles and concepts should be adhered to for optimal management. This article reviews some of these problems and hopefully provides solutions for prevention and management.

Primary augmentation/mastopexy is associated with a significantly higher complication rate than primary augmentation alone. Despite this, its popularity has steadily increased. This demand has led to the need for careful preoperative planning and surgical execution to minimize the most frequent complications. This article focuses on the authors' experience with the technical aspects of the procedure.

This article addresses the description and classification of complications following breast augmentation, presenting literature on their occurrence and some suggestions for avoiding complications. There are some excellent resources on surgical algorithms and solutions to correct or enhance these complications and revisional breast augmentation surgery listed along with sources focused on prevention of complications. My hope is that you will accept the challenge to look back and also move forward to track your personal patient data and openly and honestly share your results and data for the benefit of your colleagues and future breast augmentation patients; and even though it is difficult, when required, to be open enough to change the way you practice.

Breast implant surgery will remain a major component of the practice of plastic surgery. The future may hold promise for the introduction of new implants for the augmentation of the breast and for reconstruction. The constant demand and pressure placed on the manufacturers to keep developing new fillers are proof that satisfaction with saline implants is lacking. Today, however, the saline implant may be believed to be the safest breast implant available for clinical application. The demand necessitates that implants be used for enhancement of a woman's self image and for reconstruction. The smooth-surface implants are considered more popular and safer for patients, perhaps because it has been well documented that the shell may have been the cause of the problem. However, the constancy in holding on using and reapplying the same principles of a faulty shell may not be as scientific an endeavor as we have done in the past, and to keep placing different fillers in the faulty shell. Perhaps the lamination process used in manufacturing, the air in the shell, or wear and tear produces mechanical weakening of the shell that eventually will lead to loss of integrity of the silicone-shell breast implant. The global community is looking to plastic surgeons for a solution. The applications and the demand for breast implants are global in nature. Meanwhile, as clinicians are waiting for a new implantable breast device, they will continue to use what is available and advise patients that the implantation of a breast prosthesis is not a life-long endeavor. There is a need, however, for the implants to be maintained by the process of exchange every 8 to 10 years. Breast reaugmentation is to be performed as a standard because plastic surgeons will be waiting for further clarifications from the regulators or the scientific community. The goal is to produce a good outcome and maintain safety for the patients with a high standard of care.