There is a lot of conversation and publicity about Breast Implant Associated (BIA) Anaplastic Large Cell Lymphoma (ALCL), so Dr. Romano wanted to post this to educate and reassure patients that this is not a major issue BECAUSE it is rare, readily identifiable if it occurs and is curable. So read on.
What is BIA-ALCL?
BIA-ALCL is an extraordinarily rare and treatable type of T-cell non-Hodgkin lymphoma (which is CD30 positive and ALK negative). When it does occur, BIA-ALCL forms around the breast implant and is not a cancer of the breast tissue itself. BIA-ALCL presents more often in patients with textured implants and has an occurrence rate of 1 in 30,000 patients with textured implants.
What type of implants are associated with BIA-ALCL?
BIA-ALCL is equally associated with silicone and saline implants; the filler material inside the implant seems to have no impact on BIA-ALCL. However, the texture on the outside of the implant is associated with an effect on BIA-ALCL. As stated above, BIA-ALCL is identified more often in patients with textured implants. This may be due to the increased surface area of the implant, where biofilm bacteria can linger. The number of cases of BIA-ALCL to date remains too low to prove that textured implants cause BIA-ALCL, however, the majority of patients experiencing BIA-ALCL have textured implants. Very few cases of BIA-ALCL have been definitively associated with patients who have only had smooth implants.
What are the indications of BIA-ALCL?
Patients who have BIA-ALCL will readily notice pain, lumps, swelling, fluid collections, or unexpected changes in breast shape (such as asymmetry). BIA-ALCL usually presents as a delayed seroma- a clear fluid collection around the implant which causes unusual breast swelling. This is easily and readily identifiable and not subtle. So the diagnosis is made without delay. Quite commonly, patients observe these changes more than years after their surgical sites were fully healed. Patients who develop BIA-ALCL experience a lag time between implant insertion to diagnosis of BIA-ALCL which can be between 2 to 28 years, but on average is approximately 8 years. If there is a question, the fluid can be tested by a needle, sent to a lab to perform cytology and this can very accurately confirm or cancel the diagnosis.
Is BIA-ALCL Curable?
BIA-ALCL can be treated and cured by surgical removal of the breast implants and the surrounding scar tissue capsule (capsulectomy). Once healed, the implant can be replaced or other reconstruction options considered. It is extremely rare that patients will require more than this.
What can I do?
Before undergoing any surgery with a breast implant, educate yourself about breast implants. Talk to your surgeon about the potential benefits and risks associated with textured-surface or smooth-surface implants. After receiving implants, follow your doctor’s instructions on how to monitor the implants. Mammograms cannot identify BIA-ALCL, but are still important to monitor your breast health, especially after age 40. With mammography, always make sure your technologist is experienced in performing mammograms on patients with breast implants. Ask about the compression and displacement techniques. Magnetic Resonance Imaging (MRI) can detect ruptures or potential BIA-ALCL, so undergoing an MRI if there is swelling and a suspicion of BIA-ALCL will aid in identifying any potential issues. Make sure to give yourself regular breast self-exams. You know your body better than anyone else, so keep an eye out for anything you think to be abnormal and notify your doctor if you have any concern.
As always preached and practiced by Dr. Romano, please call the office for any questions or concerns about your breasts and we will see you immediately.
Please call if you have any questions or comments or concerns:
James J. Romano MD and staff | 415.981.3911 | firstname.lastname@example.org