2/25/2020 - Dr. David Nguyen
What is BIA-ALCL?
BIA-ALCL, or Breast Implant-Associated Anaplastic Large Cell Lymphoma, is a relatively new type of cancer that has been linked to the use of textured breast implants. Lymphomas are cancers within the body's natural immune system. Researchers believe that something within the texturing process of certain implants aggravates cells in the body's lymphatic system, which leads to long term overstimulation and the formation of cancer.
This specific cancer forms within the capsule, or the fibrous scar tissue surrounding breast implants. It is not a cancer of the breast tissue itself. It grows very slowly and can usually be cured if detected early enough.
If patients are diagnosed with BIA-ALCL, they should have both their implants and the surrounding implant capsule removed. The entirety of the primary cancer should be removed with this excision. Although it is rare that the lymphoma may spread to lymph nodes or other areas, this may need to be addressed as well.
It should also be noted that BIA-ALCL is NOT the same thing as BII, or Breast Implant Illness. We will discuss Breast Implant Illness in another post.
Am I at risk of developing BIA-ALCL?
BIA-ALCL has only been associated specifically with textured breast implants. If you have never had textured implants or textured tissue expanders, then you don't need to worry at this time. Patients who have only had smooth breast implants in their lifetime currently have no known risk of BIA-ALCL. There has not been any cases of BIA-ALCL found that involved only smooth implants. All cases have involved either a textured implant alone or a textured implant in combination with a smooth implant.
The exact risk of getting BIA-ALCL for any patient is currently unknown. Figures related to Allergan's BIOCELL implants show that it has the highest risk of BIA-ALCL out of all other textured implants. The rate varies from about 1:450 to 1:3300 patients for these implants. In general, patients across the United States with textured implants have an average risk of 1 in 30,000 for developing BIA-ALCL. There have been reports of 595 total cases around the world.
There is no known way to reduce the risk of getting BIA-ALCL in the future other than possibly removing the implants along with an "en bloc" or total capsulectomy.
Textured versus smooth implant
How Do I Know If I Have BIA-ALCL?
Unfortunately, there isn't any specific test to screen for BIA-ALCL. Usually patients will have symptoms related to their breast implants and present for evaluation with their plastic surgeon. Things to look out for include breast swelling, masses within your breasts or in your armpits, new breast pain, the development of rash, or any other changes in your breast implants. The best care you can provide for yourself is performing routine breast exams and getting mammograms as instructed by your physician.
The most common presenting symptoms of BIA-ALCL is breast swelling or fluid around the implant. It can also cause a mass to develop within the capsule surrounding the implant. These things on their own do not necessarily mean you have BIA-ALCL, but they may be signs suggesting the possibility of having it.
What Should I Do If I Think I Have These Symptoms or Signs of BIA-ALCL?
You should always first check with your plastic surgeon as soon as possible. He or she will examine you and order the appropriate tests if they are concerned that you may have BIA-ALCL. This may involve an ultrasound with aspiration of the fluid surrounding the implant if it is found. The fluid will usually be sent for CD-30 testing.
What Will Happen If I am Diagnosed with BIA-ALCL?
Your surgeon will usually need to take you to surgery for removal of your implants and an "en bloc" capsulectomy. Usually a referral will also be placed to Hematology/Oncology and Radiation Oncology doctors to determine if radiation or chemotherapy is required.
Breast Implant Removal with Total Capsulectomy
I Don't Think I Have Any Symptoms of BIA-ALCL, But I Have Textured Implants. Should I Get Them Removed?
At this point, the risks of any surgery (especially an extensive one like a breast explantation with en bloc capsulectomy) outweigh the benefit of trying to prevent BIA-ALCL, so removal is not necessary or advised. The FDA has also stated that removal of your textured implants is unnecessary unless you are specifically diagnosed with BIA-ALCL by your physician.
This also applies to patients who have Allergan's BIOCELL implants, even though these have a 6 times higher risk of association with BIA/ALCL. The overall risk of actually getting this disease is so low that it is not recommended to prophylactically remove the implants at this time.
If you feel like you would still like to remove your implants and capsule for peace of mind, it would be best to see Dr. Nguyen in consultation to discuss the risks and benefits of breast implant removal with en bloc capsulectomy.
What is an En-Bloc Capsulectomy? Is it Necessary to Perform with my Implant Removal?
A capsulectomy refers to the removal of the breast capsule that forms around any breast implants placed into the body. The body will naturally form a thin, pliable capsule of fibrous scar tissue that allows the implant to move relatively freely within it. The suffix "-ectomy" means "removal" (i.e. appendectomy refers to removal of the appendix).
"En-Bloc" means the removal of the implant, breast capsule, cancer mass along with a healthy rim of tissue in a patient formally diagnosed with BIA-ALCL. The term "en bloc" has been misused often and now colloquially refers to the complete removal of the breast capsule in any explantation patient.
I Don't Remember What Kind of Implants I Have, and I Don't Have My Implant Cards. How Do I Figure Out the Kind of Implants I Have?
Usually, the quickest way to find out your breast implant size and style is to call your plastic surgeon and request the medical/surgical records. If that is not available because your surgeon has retired, you may try calling the implant manufacturer (i.e. Allergan, Mentor, or Sientra) to see if they obtained and stored this information via their tracking mechanisms.
BIA-ALCL is a relatively new disease that we are still learning much about. If you have any other questions or concerns about it, Dr. Nguyen would be happy to see you in consultation to discuss your specific case and determine if you are a candidate for breast implant removal with total capsulectomy. Call 657-900-5055 for a free consultation now!
For more information on the FDA's website regarding Breast Implant-Associated Anaplastic Large Cell Lymphoma, click here.