Your Risk: Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

Mr Dean White is committed to ensuring his patients are highly informed about the cosmetic or reconstructive process they are about to undergo; this includes a substantial understanding of any risks involved. Breast implant surgery, either for cosmetic or reconstructive reasons, is one of the most popular plastic surgery procedures worldwide. Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is one of the less talked about risks of the procedure. Though it is very rare, Mr White believes it is essential his patients have access to the information

What is BIA-ALCL?

Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a rare kind of lymphoma which can form adjacent to breast implants, usually showing symptoms three to 14 years after the insertion of an implant. The lymphoma is treatable. It is also important to note that BIA-ALCL is not breast cancer. Where breast cancer develops in breast tissue and can grow from there, BIA-ALCL is formed in the fluid surrounding breast implants and is, in most cases, contained by a fibrous capsule around them.

What is my risk?

BIA-ALCL is a rare disease. Less than 100 women in Australia and New Zealand have been diagnosed with the condition. The rarity of BIA-ALCL makes it difficult to ascertain a precise absolute risk figure, though it is estimated to be in the vicinity of 1/1000- 1/10000 of women with breast implants. To put this in comparison, the risk of breast cancer in women is approximately 12.5% (Approximately 1 in 8)

It is not possible to predict if a breast implant patient will develop BIA-ALCL. The condition has occurred both in reconstruction and cosmetic procedures with no difference in saline or silicone implants. No cases have been reported in Australia or New Zealand regarding smooth implants – current data suggests textured implants present different risks.

What causes BIA-ALCL?

There is no certain cause of BIA-ALCL. In saying this, there are a few factors that are believed to be linked to the development of this rare lymphoma. Most experts attribute the development of BIA-ALCL to the long-term exposure and inflammatory response to the presence of bacteria. This comes after bacteria have been found within the lymphoma and around the breast implants in affected patients. Where bacteria have contaminated an implant, the body cannot heal itself. It causes severe irritation which, after an extended period, can provoke the immune system to a point where those cells can potentially turn cancerous. Genetic risks related to the disease are also being investigated. In partnership with Australian and New Zealand plastic surgeons, local and international research organisations are continuously studying the condition to improve understanding.

What are the symptoms of BIA-ALCL?

The most tell-tale signs of BIA-ALCL in breast implant patients are pain, lumps, swelling and/or asymmetry after the procedure has fully healed. Swelling and the associated pain are the most dominant symptoms of BIA-ALCL. Caused by the excess accumulation of fluid around the breast implant, this symptom can be visually detected by abnormal asymmetry. Less common are lumps, which may appear on the breast or under the armpit. Symptoms develop most commonly around 8 years after the breast implant surgery, but can be evident anywhere between three and 14 years after.

How is BIA-ALCL diagnosed?

Where symptoms are present (swelling, pain, asymmetry or lumps) the patient will be sent for an ultrasound. If fluid is detected, it will be removed and tested for BIA-ALCL through purpose-made tests that will be able to define BIA-ALCL separate from other causes of fluid collection. MRI and PET/CT scans can be utilised to determine the stage of the lymphoma, but mammograms will not diagnose BIA-ALCL.

How is BIA-ALCL treated?

Most cases of BIA_ALCL will be cured with the removal of the implants and fibrous tissue. Current treatment protocols dictate that this must be done on both breasts due to a handful of cases where development of the disease occurred simultaneously on both sides. As additional treatment is rarely required, chemotherapy and radiation are necessary only in severe cases.

Some patients will request that new implants are inserted to replace the compromised ones. While this will never be done in the same operation, smooth implants re-inserted 12 months after the removal surgery have not seen any disease progression. Investigation of the safety of this strategy is ongoing.

What early detection and preventative measures are available?

At this point, there is no reason for regular ultrasound scans for those who do not present symptoms. If there are breast implant related changes in breasts, a breast examination and further investigation may be necessary.

There is also no need for implants to be removed ‘just in case’. While breast implants are not lifelong devices and will generally need to be removed or replaced at some point, patients need not worry unless they are showing symptoms of BIA-ALCL or have separate concerns.

How can breast implant surgery be made safer?

There is an accumulation of evidence suggesting that bacteria are associated with BIA-ALCL and numerous other implant complications. Infection control standards are critical in breast surgery to both ensure optimum results, highest standards of patient safety, and the lowest risk of infection.  To assist surgeons reduce the risk of infection, a 14-step plan is in place to minimise the risk of bacteria growing around an implant.

Where can I get more information?

If you are concerned about the risk of BIA-ALCL, you can find more information the Therapeutic Goods Administration (TGA) – the government body responsible for the approval of the use of all medical devices, including breast implants. The TGA has recently updated its public information about BIA-ALCL: https://www.tga.gov.au/alerts

Mr Dean White is a highly qualified and experienced surgeon who is committed to ensuring his patients are informed in all aspects of their procedure before treatment commences. Mr White values his patients’ peace of mind when electing to undergo surgery.

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