ALCL in the news

There has been a large amount of information in the press recently about a rare type of lymphoma associated with breast implants.  Some of you have called or emailed with questions, and many of you are nervous.  As my practice has a large proportion of breast implant patients, I wanted to provide some information. Around 2011 a newly described type of cancer, a lymphoma named Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL) was discovered to be developing in some ladies with breast implants.  There was a clear association with implants, but data was very sparse.  It is important to understand that this is a very rare disease, and it has taken years to gather more data.This is not a breast cancer, but rather a type of non-Hodgkin’s lymphoma, a cancer of the immune system.  In most cases the BIA-ALCL is found in the capsule (scar tissue) and fluid around the implant, but in rare cases can spread throughout the body.The FDA has been very involved in gathering data about this disease.  The plastic surgery societies have also been extensively involved in not only educating plastic surgeons of what to look for, but also in providing information to registries and to the FDA so that we could learn more about this entity.To date, there are 457 cases of ALCL known worldwide.  Considering that 400,000 augmentations are done in the United States alone annually, this is a very rare disease.  The risk rates at this point are unknown but are estimated to be between 1:3000 to 1:30000.  A very important thing to know about ALCL and my patients in particular is that ALCL is almost always associated with textured breast implants.  The vast majority of implants I use in my practice are smooth breast implants.  While I have used textured implants on an occasional patient over the years, over 99% of my patients have received smooth implants.   I would suggest checking your implant ID card to verify that you have smooth implants.  If you are unsure or cannot find your card, we have this information on file and can provide it to you.  I believe that patients with smooth implants are at extremely low risk for ALCL based on the current data.  Even if you have textured implants the risk is extremely low but you should know the warning symptoms.So, what should you look for? ALCL usually presents with swelling of the breast years after surgery.  Patients notice a breast begins to swell and often hurts.  This usually occurs somewhere between 3 to 15 years after initial augmentation.  So, any unexplained swelling needs a visit to your plastic surgeon.  I am always happy to see any patient of mine experiencing such symptoms (and do not charge for the visit) but if you no longer live in the area you should seek evaluation by a board certified plastic surgeon.  Ultrasound imaging and biopsy is usually the recommended next step.  I wrote a blog post on my website about this in 2016 that you can also refer to for more information.The good news is that when caught early this is a very curable type of cancer.  Removal of the scar capsule is usually the only treatment needed.  Unfortunately cases that have had delayed diagnosis have led to deaths for ALCL spread.Remember, this is a very rare disease.  It is associated predominantly with textured implants.  I am sending this email as there has been a significant amount of press surrounding this and I feel that my patients should be educated with good, factual information.  The FDA says that women with implants should continue enjoying them, and that they are very safe devices. Knowledge is power, and when this disease is caught early, it is highly curable.  Thus, if you ever have unexplained swelling please call for an appointment. If you have any questions, please do not hesitate to call the office and/or email me directly.  As always,  Evan Sorokin MD

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