What is BIA-ALCL? Breast Implant-Associated Anaplastic Large Cell Lymphoma

Recent news reports such as one from ABC7 in Washington DC have been publishing scary articles about a breast implant associated lymphoma.  As more and more discussion is out there in the media, I feel the need to discuss this scary but extremely rare disease.

It is important to inform patients and potential patients about this cancer so that if symptoms do develop they act on it quickly.

It is also important not to panic or believe that breast enhancement is not safe, as ALCL is an exceedingly rare disease that appears to be associated with a very specific type of implant.

Back in 2011 the FDA cautioned about a “possible association” between ALCL and breast implants.  Over the years several studies have been undertaken in order to try to gather real statistics, numbers, and research on this disease.

So what do we know?

  • ALCL is an extremely rare disease.  Very few cases have been reported worldwide.  A recent report from Australia showed higher potential rates of 1:1000 to 1:10000 in Australia.  Other studies have shown much lower rates in epidemiological studies from 1:30000 to 1:50000.
  • In 2016 the FDA issued a report that it had received reports of 258 cases of breast implants and ALCL.  300,000 breast augmentations are performed annually.
  • BIA-ALCL is a rare lymphoma in proximity to the breast implants but not a cancer of the breast itself.
  • The disease has been associated with both saline and silicone breast implants.
  • The disease has been associated with both cosmetic and reconstructive patients.
  • The disease has been associated with textured breast implants and not smooth breast implants.  This is a very important distinction.  Because of this I have stopped using all textured breast implants as soon as I was educated of this association.  I thus recommend only using smooth, round breast implants.  Other surgeons may still use textured implants however to me there needs to be a good reason to use them.
  • ALCL is treated by removing the implants as well as the capsule around the implants.   It is the capsule that is where the disease originates and full removal of the capsule is necessary and curative.  Luckily with full removal of the capsule this is a very treatable disease.
  • How do I know if I have this?  Any sudden swelling of the breast years out from surgery needs to be investigated.  It is not normal for a breast to begin to swell years out from recovery.  The average onset of ALCL is 8 years after surgery, with cases ranging from 2 to 28 years after augmentation.  Swelling of implants out of the normal should prompt a visit to your plastic surgeon.
  • It is important for plastic surgeons to understand this relatively newly described disease process, to educate any breast implant patients about it, and to report any cases to a registry that has been created so that further research can be done.

My take home message is that ALCL is an extremely rare disease.  Don’t be alarmed by media frenzy over breast implants causing cancer.  The chance of any given plastic surgeon ever seeing a case of this occurring is very rare.  That being said vigilant followup for any swelling should be reported to your surgeon and investigated.  Through further research and patient education we will continue to monitor this entity closely.   For now I would only recommend smooth breast implants not textured ones and seek consultation with a board certified plastic surgeon if you are experiencing swelling with any currently implanted implant.

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