The impact of breast implants on the immune system has been debated since their introduction in the 1960s, linking silicone to systemic autoimmune diseases. Recent studies have shown that silicone gel can migrate from the implant capsule, triggering immune responses by proliferating immune cells and releasing cytokines, affecting T-cell function. Silicone particles can induce the release of IL-1 beta and activate the NALP3 inflammasome and B cells, causing an imbalance in regulatory T cells, responder T cells, and Th17 cells. A 41-year-old female patient with a history of breast implants presented with hyperpigmented, irregular, expanding lesions and was diagnosed withmorphea in 2017. The patient also experienced symptoms such as headaches, vertigo, polyarticular pain, dry skin, and fatigue. The medical history included silicone breast implants in 2005 (PIP brand, 395 cc) and 2014 (Silimed brand, 325 cc). The patient was diagnosed with psoriasis and Sj & ouml;gren's syndrome in 2018, and ASIA syndrome in 2021 and subsequently underwent implant removal, leading to clinical improvement. The patient exhibited poliautoimmunity, with multiple autoimmune con ditions. Postsurgery, the patient experienced controlled polyarticu- lar pain, with no new skin plaques and improved clinical status. The temporal correlation between implant placement and autoim- mune symptoms, alongside clinical improvement post-breast im- plant removal, supports the hypothesis that implants function as immune adjuvants. Genetic susceptibility and environmental fac- tors, such as silicone exposure, likely contribute to this pathology. This case highlights the potential for silicone implants to act as im- mune adjuvants and highlights the importance of multidisciplinary approaches in diagnosing and treating patients with autoimmune manifestations and exposure to adjuvants. (c) 2024 The Authors. Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Introduction and importance: BIA-ALCL is a non-Hodgkin lymphoma occurring primarily in women with textured breast implants, typically presenting as late seroma. Diagnosis involves ultrasound-guided fine-needle aspiration or core needle biopsy, followed by cytologic and immunohistochemical evaluation. Positive results show CD30 cell expression and lack ALK expression. Treatment includes removing breast implants and the periprosthetic capsule. If the lymphoma has spread, en bloc capsulectomy, immunotherapy, and chemotherapy are required. Reconstruction can be done with smooth implants or autologous tissue. Presentation of case: We present here the case of a woman with a 12-year history of microtextured breast implants, without any cancer family background, who presented with peri-implant effusion in the left breast, which tested positive for BIA-ALCL at stage IA. The patient underwent breast implant removal with total capsulectomy and posterior successful autologous tissue reconstruction, demonstrating that outcomes can be satisfactory when properly treated. Clinical discussion: Paying attention to signs in women with breast implants, beyond imaging tests, can aid in the early diagnosis of BIA-ALCL and ensure a not aggressive treatment. This approach allows the reconstruction with autologous tissue without the need of further implants. Conclusion: BIA-ALCL is a rare disease, further studies about this lymphoma can help with early diagnosis and potential prevention. Highlights:

Breast implants were introduced in 1963 by Cronin and Gerow and are widely used for reconstructive and aesthetic purposes. However, their use has been controversial due to the potential risk of developing autoimmune diseases and surgical complications such as capsular contracture. Currently, no genetic markers have been identified that are definitively associated with these complications. Therefore, we conducted a systematic review to check for the presence of genetic variants that are related to complications such as capsular contracture and autoimmune diseases in women with breast implants. A systematic review was conducted following the preferred reporting items for systematic reviews and meta-analyses guidelines. The search included databases such as Web of Science, PubMed, and Scopus, using terms such as “breast implants,” “breast prostheses,” “genes,” “genetic markers,” and “autoimmunity.” The selected studies were cross-sectional, cohort, and case-control studies that assessed specific genetic variants in women with breast implants and their association with autoimmune diseases or capsular contracture. A total of 6 cross-sectional studies and 1 case-control study were included. The findings related to autoimmune diseases showed a high prevalence of the HLA-DQ10102 variant among women with myositis associated with breast implants compared to women with myositis without implants (81.8% vs. 31.6%; OR 9.8, 95% CI 1.77–96.79). Other studies identified genetic variants associated with capsular contracture, highlighting the expression of MMP, TIMP, TNF-α, and IL-8 genes in severe contractures. Prolonged inflammation and specific genetic variants play a crucial role in the development of capsular contracture and autoimmune diseases in women with breast implants. Identifying these genetic markers could help improve the prediction and management of these complications. However, more longitudinal studies are needed to better understand the mechanisms and validate these findings.