Am I at risk of developing BIA-ALCL?

I have just been reading about people with breast implants, specifically textured implants, developing BIA-ALCL. I have never heard about this before and apparently it is a relatively new illness linked to having implants. Please could someone shed some light on this as I am worried. I've only had my implants for a year but this can develop years later. Thank you.

Doctor Answers 3

Breast implant-related ALCL

Thank you for your important question. It is completely understandable that when having surgery, especially an elective surgery like breast augmentation, you want to make sure you will remain healthy in the long-term. I would like to share with you the current research and simple facts on the breast implant-related anaplastic large cell lymphoma (BI-ALCL). Since 2011, the FDA has published a warning on the safety profile on implants stating that women with breast implants may have a very small but increased risk of developing a tumour in the capsule enclosing the implants 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.
  • Diagnosis: Most cases 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 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
  • Level of Risk
    • In 1997, approximately 91 cases of BI-ALCL had been reported. As of 2016, a total of 278 cases have been reported around the world.  To give you an idea of how rare this is, it is important to know how many women in the world have breast implants.
    • In 2014 alone, 1.3 million women (1,348,197) got breast implants. Since its first report, more than 15 million women may have gotten breast implants.
    • The Netherlands’ nationwide pathology database which holds information on approximately 9 million people with various diseases and conditions found that the incidence rate of BI-ALCL cases per 100,000 women with breast implants was just 0.1 to 0.3 per year
    • This means that women with breast implants are 2 times more likely to be struck by an asteroid than develop BI-ALCL.
    • The National Cancer Institute estimates 3 in 100 million women per year in the US are diagnosed with BI-ALCL.
  • Description 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
  • Treatment
    • Individuals are fully cured if caught early with total capsulectomy and mass removal.


In my honest opinion, you should not worry yourself. If you get a late fluid collection around your implant, your doctor should send this to be analyzed. As you do not experience any problems, I would urge you to discuss any concerns you have with your board-certified plastic surgeon.
 
Hope this information helps!


Toronto Plastic Surgeon
4.9 out of 5 stars 425 reviews

BIA-ALCL

Hello there This is a very rare condition with reports of about 1 in 300,000 patients developing this condition . It has occurred with many different types of implants .It is being researched right now so that is why such a rare disease is getting some 'air time' .
It is so rare that most plastic surgeons have never seen a case .
To put it in perspective , the lifetime risk for all women for breast cancer is 1 in 9 , and breast cancer is a much more serious condition .So yes while there is some risk the risk is small compared to the many other risks that face us all .
If you contact your surgeon they may be able to provide you with more information .
CheersTS

Terrence Scamp, MBBS, FRACS
Gold Coast Plastic Surgeon
4.8 out of 5 stars 6 reviews

BIA-ALCL ("Breast Implant Associated-Anaplastic Large Cell Lymphoma")

As of our recent American Society of Aesthetic Plastic Surgery meeting in April of 2016, there have been 278 total cases reported around the world.  This is out of millions of women with implants worldwide. Anaplastic Large Cell Lymphoma (ALCL) is an extremely rare cancer of the immune system and can occur anywhere in the body.  The National Cancer Institute estimates 1 in 500,000 women per year in the US are diagnosed with ALCL.  Having Breast Implant associated ALCL (BIA-ALCL) is even rarer with approximately 3 in 100 million women in the US diagnosed per year.   The cause remains unknown, but the majority of cases have been associated with salt loss textured implants.  Doctors speculate that this more aggressive texture may increase the chance of bacteria being trapped and chronically stimulating the immune system with a Biofilm, but we really don't know.  The chance of this happening to you is still extremely low, even with this texture.  I would recommend that you discuss this with your surgeon to understand this better.  Texture can decrease the chance of implants shifting, as well as decreasing the risk of capsular contracture when implants are placed above the muscle- so the benefits need to be balanced against the possible risks.  Different manufacturers have different textures and some may have a much lower risk of ALCL but still have the benefits. Per the FDA " The main symptoms of ALCL in women with breast implants were a delayed fluid collection around a breast implant, often years after implant placement. Notify your health care provider if you develop any unusual signs or symptoms of your breast implants"   My Advice: don't worry, but discuss this with your surgeon. If you get a late fluid collection around your implant, your doctor should send this to be analyzed.

Jonathan Hall, MD
Boston Plastic Surgeon
4.9 out of 5 stars 29 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.