American Society of Plastic Surgeons
For Medical Professionals

Algorithm Helps Manage ALCL Worries after Breast Augmentation
New Update Provides 'Rational Approach' to Evaluating Lumps and Swelling in Breasts with Implants

ARLINGTON HEIGHTS, Ill. - In the wake of a recent FDA statement linking breast implants to a rare cancer called anaplastic large cell lymphoma (ALCL), a newly updated algorithm provides plastic surgeons with guidance in managing women with breast lumps or swelling after breast augmentation. The algorithm appears in an article published on the website of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The article will be published in the June 2011 print issue of the journal.

The algorithm "specifically addresses additional diagnosis and management alternatives for management of seroma in breast augmentation patients that may relate to lymphoproliferative disorders or ALCL," writes ASPS Member John B. Tebbetts, MD, Dallas.

Stepwise Approach Guides Decision-Making by Surgeons and Patients

Dr. Tebbetts presents an update of a previous algorithm on the diagnosis and management of seromas after breast augmentation surgery. Seromas are collections of wound fluid (serum) that can develop after various types of surgery. The update was prompted by reports of ALCL and other lymphoproliferative disorders developing in women who have undergone breast augmentation. Based on these reports, the FDA has issued a statement warning of "a very small, but increased risk" of ALCL in women with breast implants.

The link to ALCL poses a challenge for plastic surgeons, because ALCL may first appear as a painful lump or swelling in the operated breast. That's very similar to the symptoms of seroma-a much more common, but less serious, problem after breast augmentation. Since the FDA statement, plastic surgeons and their patients are seeking a rational approach to diagnosis and treatment of lumps or swelling associated with breast implants.

In developing the updated algorithm, Dr. Tebbetts' goal was to "increase awareness and vigilance" for the possibility of ALCL when evaluating fluid collections occurring six months or longer after breast augmentation. The algorithm includes "a sequential set of alternatives" for surgeons to discuss with patients, prioritized to lead to an accurate diagnosis of ALCL if it's present-and to avoid unnecessary reoperation if it's not.

The algorithm can serve as a useful framework for discussion, helping patients to make an informed decision regarding their diagnostic and treatment options. For each management alternative-from diagnostic needle aspiration, to various options for reoperation, to doing nothing-the potential advantages and risks/tradeoffs are listed.

The algorithm will be further updated as more evidence comes to light. Ongoing initiatives by the FDA and ASPS, among others, will help to define the true relationship between breast augmentation and ALCL-if any. Until more definitive information becomes available, Dr. Tebbetts believes the updated algorithm will provide a valuable "interim summary of alternatives" for plastic surgeons and other health care professionals involved in the care of women with breast implants.

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About Plastic and Reconstructive Surgery

For more than 70 years, Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, and cosmetic surgery, as well as news on medico-legal issues.

About ASPS

The American Society of Plastic Surgeons (ASPS) is the world's largest organization of board-certified plastic surgeons. Representing more than 8,000 member surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 93 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery.

About Wolters Kluwer

Wolters Kluwer is a global leader in professional information services. Professionals in the areas of legal, business, tax, accounting, finance, audit, risk, compliance and healthcare rely on Wolters Kluwer's market leading information-enabled tools and software solutions to manage their business efficiently, deliver results to their clients, and succeed in an ever more dynamic world.

Wolters Kluwer reported 2015 annual revenues of €4.2 billion. The group serves customers in over 180 countries, and employs over 19,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands. Wolters Kluwer shares are listed on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Wolters Kluwer has a sponsored Level 1 American Depositary Receipt program. The ADRs are traded on the over-the-counter market in the U.S. (WTKWY).

Wolters Kluwer Health is a leading global provider of information and point of care solutions for the healthcare industry. For more information about our products and organization, visit, follow @WKHealth or @Wolters_Kluwer on Twitter, like us on Facebook, follow us on LinkedIn, or follow WoltersKluwerComms on YouTube.


Patient Care Center