In this article, we discuss BIA-ALCL, or Breast Implant Associated – Anaplastic Large Cell Lymphoma. See TGA website for more information.
What is BIA-ALCL?
BIA-ALCL is rare and the risk of developing it has shown to differ in different populations and with different types of implants.
In the vast majority of cases, the disease is in the fluid localised around the implant and within the capsule, and is curable.
Which types of breast implant have been linked to BIA-ALCL?
Polyurethane coated and macro textured implants have much higher risk of developing BIA-ALCL. The cause is not yet known and the most accepted theory suggests a link between larger implant surface (texture) and biofilm (contamination) leading to chronic inflammation.
The were a few cases of ALCL with smooth implants. All had been implant replacement after textured implants were removed.
What should I do if I have textured breast implants?
At the moment there is no recommendation to remove implants if you are asymptomatic. It is recommended to have breast implant follow-up every 12 – 24 months with a specialist plastic surgeon.
What are the most common signs of ALCL?
- Sudden or persistent swelling
- Appearance of a lump in the breast or armpit
- Changes to the shape and feeling of your breast
BIA-ALCL can be asymptomatic in early stages. Routine follow-up is important.
Initially, Dr Rodrigo will perform an assessment and examination. He may also request additional tests (Ultrasound or MRI). If fluid is found around the implant, he will request ultrasound guided fluid collection and testing with specific pathology panel for diagnosis of BIA-ALCL.
Breast implant revision surgery
Patients undergoing revision surgery should receive information about BIA-ALCL. Remember that the implant is a “foreign body on loan”, and it will need revision surgery sooner or latter.
Some patients may develop problems with their breast implants, such as: capsular contracture, malposition or implant rupture. On other hand, you may just want to change the size of your breast, or improve the breast shape with a mastopexy (breast lift).
Dr Rodrigo Teixeira will discuss BIA-ALCL with you, especially if you have polyurethane coated or textured breast implants. He will request an ultrasound scan to check for fluid and lumps. It is ideal to diagnose BIA-ALCL before surgery and proceed with further investigations and referral to a oncologist / haematologist. Most commonly, old implants will be removed with full capsulectomy.
Moreover, intra-operative unexpected findings may require immediate attention. Your surgeon\’s experience will guide any necessary change of the surgical plan, such as: perform full capsulectomy and collect fluid and tissue testing.