Bilateral breast implant-associated anaplastic large cell lymphoma presenting as late peri-implant effusion: a case report

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare T-cell lymphoma strongly associated with textured breast implants; bilateral synchronous disease is exceptionally uncommon. We report a 51-year-old woman with 6 months of right breast swelling, 20 years after bilateral augmentation and 3 years after revision surgery. Imaging showed bilateral peri-implant effusions with irregular capsular thickening. Ultrasound-guided aspiration revealed malignant cells suspicious for high-grade lymphoma, and staging positron emission tomography-computed tomography (PET-CT) showed no distant disease. The patient underwent bilateral en-bloc capsulectomy with removal of both implants. Using the tumor, node, metastasis staging system for BIA-ALCL, the disease was classified as T3N0M0 (Stage IC) bilaterally. Histopathology confirmed bilateral BIA-ALCL with CD30-positive, anaplastic lymphoma kinase (ALK)-negative cells. Postoperative PET-CT showed patchy metabolic activity, but biopsy confirmed a foreign body giant cell reaction without residual malignancy. Bilateral BIA-ALCL should be considered with late peri-implant effusion even when symptoms are unilateral, and suspicious postoperative PET-CT findings require histological confirmation.