Does seroma in context with implant rupture definitely indicate a ALCL tumor? (Photos)

After hard garden work my right breast started to swell and harden ultra sound showed a damaged implant and fluids. MCR with contrast liquids revealed seriously ruptured implant exposing the tissue to a lot of pressure. my plastic surgeon suggests to have a biopsy done to avoid the slightest risk of an ALCL tumor. The radiologist excludes this option a 100% I am scheduled for 14/11 both biopsy and surgery. My implants are 4 years old, textured silicon. I am a bit scared now and confused

Doctor Answers 2

Does seroma in context with implant rupture definitely indicate a ALCL tumor?

Thank you for your question.  The answer is no it is possible to have a seroma in association with implant rupture and not have A LCL.  However it is extremely important to rule out this diagnosis the same biopsy of the capsule once the implant and capsule are removed is necessary to be safe.

Concerns regarding BI-ALCL

Thank you for your important question.

It is completely understandable that you are concerned and confused.

To simply answer your question - seroma does not definitely indicate an anaplastic large cell lymphoma. However we have to err on the side of caution. Let me explain.

BI-ALCL is a purely T-cell lymphoma arising either in the fluid or fibrous capsule surrounding the breast implant. T-cells are the same immune cells that get attacked by HIV, and they work to get rid of specific foreign materials and are highly important to our immunity.

Studies have shown that most cases  (66%) of ALCL are diagnosed during implant revision surgery for a seroma - collection of fluid in the implant pocket.

  • Around 66% of BI-ALCL cases present with seroma after 1 year along with the following symptoms: pain, breast lumps, swelling, or breast asymmetry
  • In the rest of the 33% of BI-ALCL cases, there just appears to be a capsular mass – a tumour of the capsule

Risk factors – Research has not conclusively identified risk factors and causal factors, but some studies suggest, the following may be associated:

  • The presence of a bacterial biofilm around the implant – this may cause delayed immune reaction, and excessive division of T-cells
  • Textured implants
  • A consequence of capsular contracture or repeated capsular tears
  • Genetic predisposition
  • An autoimmune disease
Here is some data from of previous cases
  • The mean age of the patients was 52 years (range 28–87 years)
  • The most common length of time between implantation and diagnosis of BI-ALCL was 9 years (range 1-32 years)
  • 70% of cases have a malignant fluid collection (seroma) around the fibrous capsule surrounding the implant after 1 or more years
  • 30% of cases have a distinct tumour mass of the implant capsule and this may be a more severe form


  • Individuals are fully cured if caught early with total capsulectomy and mass removal.
Your plastic surgeon is doing the right thing by ordering a biopsy.
I hope this better informs you and reduces some confusion. You should remain positive and hopeful.
Please take care.

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 414 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.