What Patients Need to Know – Breast Implant Associated Anaplastic Large Cell Lymphoma

What Patients Need to Know – Breast Implant Associated Anaplastic Large Cell Lymphoma

Oren Lerman, M.D., FACS, Associate Professor of Surgery, Donald & Barbara Zucker School of Medicine

Recently, there has been a significant amount of media coverage regarding breast implants and a rare lymphoma that has been found in extremely rare cases called “BIA-ALCL” or Breast Implant Associated Anaplastic Large Cell Lymphoma. Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare type of lymphoma that can develop in the scar capsule around either saline or silicone breast implants. BIA-ALCL is not a cancer of the breast tissue itself. It is not specific to saline or silicone implants and can occur in cosmetic as well as reconstructive patients. It is currently believed that all cases of BIA-ALCL have presented in woman who have had a textured implant at one point in time, but this is still under investigation. A textured breast implant is one that has been manufactured with a rough exterior shell that prevents is from rotating around the pocket in the body.

The family of ALCL is a rare cancer of the immune system, which can occur anywhere in the body. The US FDA estimates the total known number of cases of BIA-ALCL to be 450-550. Because it is so rare it is currently estimated that the lifetime risk of BIA-ALCL is only between 1:1,000 to 1: 30,000 for women with textured breast implants.

The most important things to remember are:

  • This illness is extremely rare and highly treatable. Most plastic surgeons have never treated a patient with ALCL because of how rare it is.
  • Breast Implant reconstruction after mastectomy remains the most common type of reconstruction in the United States.
  • The lifetime risk of breast cancer is 1 out of every 8 women whereas the risk of BIA-ALCL is somewhere between 1:1000 – 1; 30,000.
  • No one (neither the FDA, the National Institute of Medicine, the National Cancer Institute, the implant device manufacturers or the national physician societies) is currently recommending the prophylactic removal of breast implants in order to prevent BIA-ALCL because of how rare it is.
  • What is most important is to undergo routine examination and follow up with your physician.
  • Patients with breast implants should be followed by a surgeon over time and seek professional care for implant-related symptoms such as pain, lumps, swelling, or asymmetry.
  • Patients should monitor their breast implants with routine breast self-exams and follow standard medical recommendations for imaging (e.g. Mammography, Ultrasound, MRI).
  • The majority of patients present as a delayed seroma (fluid collection), but also present with symptoms of mass, skin rash, fever and night sweats, and enlarged lymph nodes.
  • Mammograms are not helpful for evaluating lymphoma but are important for the routine screening for breast cancer.  
  • The FDA recommends MRI to rule out ruptured silicone implants (which is not known to be related to BIA-ALCL) every 2 years
  • The most common complications of breast implants are not related to BIA-ALCL at all. They include capsule contracture (hardening of the implant), Implant rupture (leaking), implant infection, asymmetry, malposition. Any of these may require revision surgery.
  • The federal government mandates that revision surgery to correct problems with breast reconstruction must be covered by insurance.
  • Natural Tissue reconstruction (Autologous Reconstruction) can be used as an alternative to breast implants in most women who have had breast reconstruction in the past with implants.    

For more information: visit www.plasticsurgery.org/alcl 

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