Am I at risk of developing BIA-ALCL?
Doctor Answers 4
Breast implant-related ALCL
- 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
- 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!
I thought I'd share with you what how our practice counsels people about the recent news updates on ALCL (Breast Implant Associated - Anaplastic Large Cell Lymphoma).
Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)
March 2017 Update
What is ALCL?
This is an extremely rare form of lymphoma (a white blood cell cancer) that has recently been associated with breast implants. It is very treatable with implant removal and removal of the scar tissue around the implant (removal of the capsule). Additional treatment may be necessary on a case-by-case basis. This is NOT a cancer of the breast tissue itself, but rather of the scar tissue around the implant.
What are the numbers?
This link was identified in 2011, and has been tracked by the FDA and other groups to research the problem. The American Society of Plastic Surgeons (ASPS), to which all 6 of our Monarch plastic surgeons belong, has also been instrumental in collecting data.
On March 21, 2017, the FDA released a report of the numbers to date. As of this update, we know of 126 unique cases of this disease ever occurring in the U.S. since we have been tracking it. It is important to understand that about 275,000 breast augmentation operations occur in the U.S. every year. This does not include another 100,000 or so implants placed per year for breast cancer reconstruction. That would be 126 cases identified in the past 6 years out of about 2.3 million procedures (0.000056% chance of getting the disease).
Even though these risks are extremely small, we still are paying close attention and continuing breast implant research.
What should about textured-surface vs smooth-surface breast implants?
So far, as the numbers are more closely studied, there are no CONFIRMED cases of the disease occurring around smooth-surface breast implants (by far the more common implants used for cosmetic augmentation). All of the confirmed cases seem to be in association with the textured-surface implants, such as the Style 410 anatomically-shaped (tear drop) implants our practice sometimes uses. We can get information about your implants to you.
What about silicone versus saline filled implants?
This problem has been described for both types of implants, so the fill material does not seem to contribute to the disease.
What should I do?
The FDA and ASPS recommend that you do nothing differently if you already have implants. You should be seen at least yearly by your plastic surgeon, and more often if you are a breast cancer reconstruction patient. We can help you determine any further steps required. More than likely, yearly examinations in our offices, self-breast examination, and routine mammograms are all that will be necessary. Please contact your surgeon with specific questions about your case.
Keep in mind that this news was not meant to cause a panic among patients, but we do want to be sure you are cared for. If you have new swelling, pain, redness, or masses in your breasts, please get care from us as soon as possible.
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 .
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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.
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.