Table. Summary of cases of BIA-ALCL in Germany.

	Case 1	Case 2	Case 3	Case 4	Case 5	Case 6
Indication	SSM after bilateral breast CA, right-sided radiotherapy	Esthetic augmentation	Bilateral NSM in right breast CA + DCIS and left LIN I	NSM in bilateral fibrocystic mastop‧athy with atypia	Esthetic augmentation	Breast ablation with delayed implant reconstruction 2 years later
Implant type and interval before BIA-ALCL manifestation	Initially bilateral expanders (manufacturer unknown), exchanged after 4 months for bilateral textured implants (Allergan), left implant exchanged (McGhan) with reinforced acellular dermal matrix (Strattice), left BIA-ALCL 5 years later, no abnormality to date on the right	Bilateral textured implants (Allergan), left BIA-ALCL 5 years later	Macrotextured implants (Polytech) + titanium mesh (TiMesh), right breast BIA-ALCL 8 years later	Initially expander implants (McGhan) left implant exchanged for Mentor CPG after 8 years, left BIA-ALCL 5 years later	Initially bilateral McGhan, exchanged for Allergan after 9 years, right BIA-ALCL 9 years later	Silimed implant (texture unspecified), BIA-ALCL 7 years later
Preoperative diagnostic procedures	In seroma of left breast: sonography with aspiration, CT, MRI	Palpation left axilla (tumor, not seroma), sonography, MRI, CT, bone punch biopsy	Seroma of right breast: MRI (finding: “spongious material”)	Left seroma and extensive tumor: sonography, CT	Right seroma: sonography	Left seroma: sonography
Pathology/ stage/TNM	CD30-positive seroma, capsule not involved/1A/ T1N0M0	CD30-positive tumor, 1B (left)/T2aN0M0	Aspirate initially not analyzed for CD30, histology initially inconspicuous, on second look demonstration of ALCL with infiltration of capsule/1C/T3N0M0	CD30-positive ALCL,R1 resection to thoracic wall/2A/ T4N0M0	CD30-positive ALCL, R0/1A / T1N0M0	CD30-positive ALCL, R0/1A/ T1N0M0
Treatment/ follow-up	Left complete capsulectomy / recurrence-free for 12 months, bilateral autologous conversion planned	Bilateral capsulectomy and implant removal + autologous conversion, recurrence-free for 12 months	Capsulectomy and implant exchange, chemotherapy (CHOP scheme), recurrence-free for 23 months	Capsulectomy and tumor resection (R1), chemotherapy (CHOP-14/G-CSF), radiotherapy, recurrence-free for 24 month, lost to follow-up 8 years ago	Capsulectomy, implant exchange, recurrence-free for 6 months	Capsulectomy and local flap repair, recurrence-free for 6 months

We have included six of the seven German cases registered to date at the Federal Institute for Drugs and Medical Devices (BfArM).

BIA-ALCL, Breast implant-associated anaplastic large-cell lymphoma; CA, cancer; CHOP, cyclophosphamide, hydroxydauromycin, oncovin, prednisone;

CT, Computed tomography; DCIS, ductal carcinoma in situ; LIN, lobular intraepithelial neoplasia; MRI, magnetic resonance imaging; NSM, nipple-sparing mastectomy;

SSM, subcutaneous mastectomy; TNM, tumor, node, metastases (classification system)