BIA-ALCL – Symptoms, Diagnosis, and Treatment of Breast Implant-Associated Lymphoma

Understanding the Risks of BIA-ALCL – Breast Implant-Associated Anaplastic Large Cell Lymphoma

The FDA in the USA has done extensive research about the safety of implants over many years. Recently, researchers and medical professionals have identified a rare form of cancer, known as Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), which is specifically linked to textured implants. It’s crucial to distinguish this medical concern from symptoms reported by some women related to Breast Implant Illness (BII).

You must know the signs and symptoms associated with BIA-ALCL so that the diagnosis is not delayed. Prompt surgical intervention for BIA-ALCL, involving the removal of both the implants and the surrounding capsule en-bloc, has demonstrated highly favourable outcomes.

What is BIA-ALCL?

Breast Implant-Associated Anaplastic Large Cell Lymphoma, or BIA-ALCL for short, is a type of T-cell lymphoma, a cancer of immune cells that can develop in patients with certain types of breast implants. Since it develops from immune cells and not actual breast tissue, it’s not considered breast cancer even though it arises in the breasts. Cancer cells are usually detected in the fluid (effusion) that might accumulate around the implant, or in the surrounding scar tissue (capsule). BIA-ALCL is usually not aggressive and grows slowly, however, in some cases, it might extend to other body parts if left untreated.

Illustration courtesy of the United States Food and Drug Administration (FDA) –

Risk Factors for BIA-ALCL

Since BIA-ALCL is still a relatively new discovery, doctors still do not know very much about how it exactly develops. According to the Australian Society of Plastic Surgeons (ASPS), there are a few factors that increase the risk of breast implant cancer:

  • Textured implants: This is probably the most well-established risk factor. Almost all the cases of BIA-ALCL reported worldwide (a total of 885 so far) are in women who have textured implants. Most of these implants were from a single manufacturer called “Allergan.” Smooth breast implants have, on the other hand, NEVER been directly linked to breast implant lymphoma. Researchers and doctors have theorised that the chronic inflammation caused by the rough sandpaper-like shell of textured implants might be a cause of lymphoma formation.
  • Bacterial contamination: Sometimes during surgery, contamination of the implant with pathogenic bacteria may occur, causing inflammation. This is believed to increase the risk of BIA-ALCL.
  • Time since surgery: On average, BIA-ALCL happens after 7-10 years of implantation.
  • Genetic predisposition: Mutations in the JAK1 and STAT3 genes may cause BIA-ALCL.

Symptoms of BIA-ALCL

The most important thing you need to know about breast implant-associated cancer is the symptoms. By knowing these, you will be able to promptly share your concerns with your plastic surgeon. Here are some symptoms you need to look out for:

  • Breast swelling
  • Fluid accumulation under the skin (seroma)
  • Painful breast
  • Breast lump
  • Redness
  • Changes in breast shape
  • Asymmetry between your two breasts
  • Swelling or lumps in the armpit area

It is important that you do not delay seeing your plastic surgeon for a breast implant check-up. Early diagnosis of breast implant-associated lymphoma is critical for treatment.

Statistical Risks of BIA-ALCL

According to the Australian Therapeutic Goods Administration (TGA), one in every 2500 to 25,000 people with breast implants in Australia ends up developing BIA-ALCL, with all the previously reported cases having textured implants and not smooth breast implants.

Recent studies suggest that the risk of developing complications such as BIA-ALCL could range from 1 in a thousand to 1 in 10,000 for patients with textured implants. Consequently, there is growing patient interest in either removing textured implants altogether or exchanging them for smooth breast implants.

Diagnosis of BIA–ALCL

First, your plastic surgeon will start by asking you about your symptoms and details about your breast augmentation such as the type of breast implants you have. After that, he/she will examine your breasts and armpits and try to feel the lump/swelling that’s concerning you. If your plastic surgeon suspects that you might have BIA-ALCL, he/she will order one of the following tests:

  • Ultrasound imaging (echography): It’s an imaging technique that can easily detect any fluid, masses, or lymph nodes near your implants.
  • Magnetic resonance imaging (MRI) scanning: MRI is an advanced imaging modality that can also detect any tissue abnormalities in your breasts.
  • Needle biopsy: If echography or MRI scanning shows something near your implants, your surgeon will try to take a biopsy. He/she will try to aspirate the fluid or take part of the tissue through a needle to send it to the lab for testing.
  • CD30 testing: CD30 is a receptor found on activated T-cell lymphocytes. The fluid aspirated by your surgeon will be sent to the lab to undergo CD30 testing. If the test result is positive, further testing will be needed before ruling out BIA-ALCL.

Thankfully, the current treatment of BIA-ALCL has shown to be effective and has provided an excellent prognosis with nearly 93% of patients becoming disease-free after 3 years.

Following thorough testing and staging conducted by an oncologist, they will collaborate with you to discuss and establish a personalised treatment plan.

Treatment options for breast implant-associated lymphoma include:

  • Surgery: Surgery has been the cornerstone of treatment for BIA-ALCL. A specialist plastic surgeon can remove the old implants in one piece (En-bloc or complete capsulectomy excision) along with the surrounding fibrous tissue capsule (capsulectomy). If the surgeon finds any affected lymph nodes, he/she may also remove them as they may be cancerous. Surgically removing the implant and capsule has been found to be the most effective treatment for BIA-ALCL.

Other treatment options include:

  • Chemotherapy: In the unlikely event that surgery is not enough, chemotherapeutic agents may be given.
  • Radiotherapy: Rarely, this might be needed in addition to surgery.
  • Stem cell transplant: It is still being investigated.

Since this operation is more extensive compared to normal implant removal surgery, surgical removal of the implant and the surrounding fibrous capsule is best performed by a specialist plastic surgeon. In most cases, your breasts can also be reconstructed using new implants or a breast lift after treating BIA-ALCL.

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