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Key Facts about Breast Implant Associated ALCL

What is BIA-ALCL?

• It is a rare cancer of lymphatic cells and a form of Non-Hodgkin’s Lymphoma
• It is not a breast cancer
• First reported nearly 20 years ago

Who is affected by BIA-ALCL?

• Women who have had breast implants for either cosmetic or reconstructive reasons
• Based on the research we have so far it has only been found in women who have had textured breast implants (so far no cases of BIA ALCL have been found in women with smooth  breast implants).

What causes BIA-ALCL?

Based on the information we have to date, it is widely accepted that there are 4 related or unified parts that play a role in the cause of BIA-ALCL:

1. Textured surface Breast Implants
2. Bacterial contamination or a biofilm deposited onto the surface of textured breast implant at the time of surgery
3. One's own genetic predisposition
4. Time - through the process of time inflammation

What is the risk of developing BIA-ALCL?

In contrast to the the risk of developing breast cancer (1:8 women), the risk of developing BIA-ALCL is still very low, however, these figures are constantly changing as new information becomes available.  Research to date tells us:

• Smooth Breast Implants - currently 0 cases of BIA-ALCL reported to date with smooth implants alone.
• Microtexture eg. mentor siltex or similar - 1:82 000
• Macrotexture eg. Allergan Biocell or similar - 1:3200
• Polyurethane eg. Furry Brazilians 1:2800

Why do textured implants  have a higher risk of developing BIA-ALCL than smooth breast implants?

There are several thoughts or ideas around this topic, here are some of the ideas:

• Greater texturing appears to be associated with greater surface area and therefore more area to attract bacteria around the breast implant.
• Bacteria forms a biofilm around the implant which in turn can cause chronic inflammation
• Some studies have also discussed that textured implants may result in mechanical rubbing and therefore chronic irritation.

What signs or symptoms should I watch for?

• A presentation of swelling of the breast anywhere from 2-28 years after the insertion of breast implants.
• Swelling may increase over days or weeks
• Swelling is due to a collection of fluid accumulating around the breast implant  between the scar capsule and the implant itself
• A lump in the breast or armpit
• Breast Firmness and or pain on touch
• On average it has been found around 7-10 years after initial breast implant surgery.

What should I do if I notice symptoms?

All women should consult with their GP and Plastic Surgeon immediately if they notice:

• a change in size, feel or shape of their breasts
• lumps in their breasts or underarm area
• Breast pain on touch
• If the disease is diagnosed early in most cases BIA- ALCL can be cured with surgery.

How can my surgeon test my breast implants for BIA-ALCL?

Typically if a woman presents with swelling and has a history of breast implants, she should speak to her GP and her Specialist Plastic Surgeon immediately.  Typically the following is arranged to diagnose BIA-ALCL:

• Ultrasound scan to detect if extra fluid called a seroma is present around the breast implant
• If fluid around the breast implant is found, this fluid is drained or aspirated and sent away for specialised testing.
• Fortunately most fluid or seromas are benign and not BIA-ALCL.

How is BIA-ALCL treated and can it be cured?

• Treatment often involves bilateral capsulectomy (removal of the capsule or scar tissue surrounding the breast implants) along with the current breast implants and replacement with another breast implant such as a smooth breast implants or alternatively removal of the breast implant altogether.
• If treated early, BIA-ALCL can be cured with no additional treatment other than surgery.
• If diagnosis is delayed or the disease has spread to lymph nodes or nearby tissues, chemotherapy and/or radiation may be required in addition to surgery for curative treatment.

Have there been any deaths caused by BIA-ALCL?

• At this stage global data has confirmed 17 deaths since reports of BIA-ALCL 20 years ago.

Should I have my breast implants removed because of the BIA-ALCL risk?

• Based on current research and advice women with textured implants and no clinical signs or symptoms DO NOT need to have their breast implants removed or replaced because of the risk of BIA-ALCL.
• Breast Implants do not last forever and will need replacement at some point
• Periodic follow up with your Specialist Plastic Surgeon is recommended to ensure your breast implants are intact and you have no symptoms.

How often should I have my breast implants checked?

Breast Implants don't last forever, I now recommend having your breast implants checked every 3 years after your initial surgery and then every 2 years after that.

Dr Eddie Cheng's take home message

1. Breast cancer surveillance including self-breast exams and screens such as mammograms/ultrasounds are still the most important check ups for all women over 40.
2. Contact your Plastic Surgeon and GP immediately if you notice any changes in the shape, feel and size of your breasts and breast implants.
3. BIA-ALCL is relatively rare and more often than not investigations return a normal or benign result.
4. Stay in touch with your plastic surgeon and keep of copy of your own breast implant records as you will need to remove and replace these devices at some point in the future
5. Be familiar with The Australian Breast Implant Device Registry and keep your contact details current so that the device registry can stay in touch and keep you informed of any new developments or research.
6. If you you have any concerns about your general health and think it might be caused by your breast implants, speak to your GP and Specialist Plastic Surgeon for further information to help you consider your options moving forward.

Or visit our Breast Augmentation and Implant page for more information

Dr Eddie Cheng is a board certified Specialist Plastic Surgeon in Brisbane, Australia.  Socialise with us @arplasticsurgery to learn more about Dr Eddie Cheng and our Team. This information was compiled based on information produced by The Australian Society of Aesthetic Plastic Surgeons and The American Society of Aesthetic Plastic Surgeons.

Magnussan. M, Deva. A, Ashton. M (October 2017). Statement on Breast implant associated-Anaplastic Large Cell Lymphoma (BIA-ALCL). Retrieved from https://aestheticplasticsurgeons.org.au/news/statement-breast-implant/.

The American Society of Aesthetic Plastic Surgeons (February 2019). BIA-ALCL Talking Points/FAQs as of February, 2019.  Retrieved from https://www.surgery.org/sites/default/files/BIA-ALCL-Talking-Points-2-13-19.pdf.