Recently, the doctors at the Perinatal Centre of Almazov National Medical Research Centre performed a unique surgery for breast implant-associated large cell lymphoma in a pregnant woman. This is an extremely rare diagnosis (the 8th case registered in Russia, for the first time in a pregnant woman) with a prevalence of one per 12,000 implantation cases and is associated with chronic inflammation, genetic predisposition (JAK1/STAT3 mutations) and the use of macrotextured implants. Different countries maintain their own statistics on these cases, with most cases reported in the United States.
As a rule, only surgical treatment is needed to remove the entire capsule surrounding the implant with a margin of healthy tissues, and in the absence of other signs of lesion, systemic treatment is not required.
The patient who sought medical help at Almazov Centre is 36 years old and is pregnant with her first child without complications.
At the age of 22, the woman got breast implants, and 10 years later, a seroma (buildup of fluid) appeared within the implant capsule. Her implants were replaced, but the seroma persisted for the last 4 years. During pregnancy, a marked asymmetry in the volume of the mammary glands occurred, and this rare diagnosis was made by immunocytochemical study of the serous fluid.
Before surgical treatment, the pregnant woman and the fetus were thoroughly examined. After that, surgeon, oncologist/mammologist Alexander Shemerovsky performed a surgery together with obstetricians-gynecologists (head of the Department of Pregnancy Complications N. A. Osipova and obstetrician-gynecologist E S. Shelepova), who carried out continuous fetal monitoring during surgery.
Both implants with the surrounding capsules were removed as a single block. The surgery was uneventful, histology of the capsule showed that lymphoma was in stage 0 and did not require chemotherapy.
“Now the patient is healthy, she will be able to have a natural delivery in 11–12 weeks at the Perinatal Centre and her breastfeeding ability is preserved. After the end of lactation, breast augmentation can be repeated if she wishes so, but only with smooth implants or fat transfer (such procedures are performed at Almazov Centre),” explains Dr. Shemerovsky.
