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What is Breast Implant Associated Anaplastic Large Cell Lymphoma, and am I at risk?

breastexamination

Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) has cropped up in the media lately, leaving some people concerned and confused about the condition, and their risk of developing it. We take a look at what BIA-ALCL is, what the risks are, and what you should do if you are concerned you might be affected.

What is BIA-ALCL?

Breast Implant Associated Large Cell Lymphoma is rare type of lymphoma which can form in tissue adjacent to polyurethane and textured breast implants. It is an extremely rare condition; to date there have only been about 50 cases identified in Australia, and 10 in New Zealand.

Is BIA-ALCL breast cancer?

Breast Implant Associated Anaplastic Large Cell Lymphoma is not breast cancer. In most cases, the complete treatment for this condition is to remove the implants as well as the fibrous capsule that has formed around them. In some cases it may be necessary to complete additional treatment in the form of chemotherapy or radiotherapy, but this is rare.

What are the symptoms of BIA-ALCL?

The most common symptom of Breast Implant Associated ALCL is persistent swelling, which is generally accompanied by pain. Where the lymphoma develops around the breast implant, excess fluid accumulates, causing the swelling. Symptoms are usually apparent between three and 14 years after the insertion of the implant, most commonly around the eight-year mark. The disease can, in some cases, appear in the form of a lump in the breast or armpit, or as abnormal asymmetry in the breasts.

What is the risk of developing BIA-ALCL?

This disease is considerable rare, affecting an estimated 360 people worldwide. Its rarity means that determining the absolute risk of developing BIA-ALCL is uncertain; however, it is estimated that about one in 5000 women with breast implants will develop the condition.

Are some women more at risk than others?

There is no significant data to determine who is more at risk of developing BIA-ALCL. It is not possible to predict if someone is at risk of developing the condition, though to date it has occurred in women who received textured implants rather than smooth ones.

How is BIA-ALCL diagnosed?

Where symptoms are present and fluid is detected, a test is conducted to exclude or diagnose Breast Implant Associated ALCL. Most fluid collections around breast implants are unrelated to BIA-ALCL, and proper testing will be effective in telling them apart to develop a diagnosis. In confirmed cases, MRI and PET/CT scans may be performed to help determine the stage of the disease. Mammograms will not detect BIA-ALCL.

Should women with breast implants be screened for BIA-ALCL?

At this point, women with breast implants do not need regular ultrasound scans if symptoms are not present. However, any abnormal changes in the breasts may need further investigation.

What is the treatment of BIA-ALCL?

Most cases require only the removal of the implants and surrounding fibrous tissue with no further treatment. Additional treatment such as chemotherapy and radiotherapy are rarely required.

Do we know what causes BIA-ALCL?

Bacteria have been found within the lymphoma and around implants in affected breasts that would suggest a link to BIA-ALCL. Evidence is accumulating to support the concept that it is a long-term inflammatory response to the bacteria that over-stimulates the immune system to develop the disease. However, studies into this disease are continuing in order to find a definite cause.

Are there ways to make breast implant surgery safer?

Breast implant surgery is made safer through strict infection control methods. A 14 point plan developed for surgeons to minimise the risk of infection in breast implant surgery has been implemented. It outlines necessary steps for doctors to take to ensure the lowest risk of bacteria around implants.

What should you do if you are concerned about your breast implants?

If you are concerned about your breast implants, step one is to contact your surgeon or get a GP referral to a specialist plastic surgeon. If you are experiencing symptoms, you will likely receive an ultrasound and tests to exclude or diagnose BIA-ALCL.

Can new breast implants be inserted when BIA-ALCL is treated?

Implants cannot be replaced in the same operation, though smooth implants have been re-inserted following BIA-ALCL treatment without disease progression. The safety of this strategy is still being investigated.

Where can I find more information?

The Therapeutic Goods Administration has recently updated public information about BIA-ALCL. Read more here: https:/www.tga.gov.au/alerts

What should I do if I am considering breast implants?

If you are considering breast implant surgery, be sure to make yourself aware of BIA-ALCL and discuss the risks with your doctor.

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