BIA ALCL - pain in breast.

Question

Oct/16 I had a very painful left breast. Went to ER. With fever/chills blood work/ X-ray normal, ultra sound done on a later date. ER gave me Antibiotics for 10 days. Ultrasound fluid around a lump. 10 days of Antibiotics I felt better. Before I could barley stay awake, back hurt had a fever of 100. My PS mentioned ALCL. The lump biopsied negative. Still tired. I still have the lump in my breast with pains. Is it possible that I have ALCL? Would Antibiotics cleared up the fluid around the lump?

Terrence Scamp, MBBS, FRACS · Answer

Hello there ALCL usually presents 8 or more years after augmentation with a painless swelling on one side .This doesn't fit the pattern that you are describing . That sounds more like an acute infection .If there is a lot of fluid around the implant then it might be possible to take some of this off and have it examined .This may show an infection and can also be used to exclude ALCL .You need to stay in contact with your surgeon and take his/her advice .CheersTS

Martin Jugenburg, MD · Answer

You must be tired and concerned after the ER visit, the fevers, etc. Antibiotics cannot clear off the fluid around lumps. You can and probably should go back for repeat testing if you are highly concerned.I am unsure when you had your breast augmentation surgery, but I would like to share some information from a recent research review paper on breast-implant associated anaplastic large cell lymphoma (Clemens, M. W., &
Miranda, R. N. (2015). Coming of Age. Clinics in Plastic Surgery, 42(4),
605–613). I summarize the information below for your knowledge.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

BIA-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 associatedThe presence of a bacterial biofilm around the implant – this may
cause delayed immune reaction, and excessive division of T-cellsTextured implantsA consequence of capsular contracture or repeated capsular tearsGenetic predispositionAn autoimmune disease

Level of RiskIn 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 yearThis 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 casesThe 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 years30% 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. Please refer back to your surgeon to ask them more about the condition.Hope this helps.

Steven Wallach, MD · Answer

You need to be evaluated in person. If you have a lump then it needs to be investigated. Best of luck.

Edward J. Domanskis, MD (in memoriam) · Answer

If you have a lump in your breast with or without breast implants it should be biopsied. Mammograms, ultra sound or MRI will not totally give you the diagnosis if it is cancerous.

BIA ALCL - pain in breast.

Answers (4)

Answer: What should I do if I have a lump in my breast?

Answer: What should I do if I have a lump in my breast?

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BIA ALCL - pain in breast.

Answers (4)

Answer: What should I do if I have a lump in my breast?

Answer: What should I do if I have a lump in my breast?

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Recommended reading

Everything you need to know about Breast Augmentation

Our mission is to create a world where every investment in modern beauty is Worth It.