Breast Implant-Associated Anaplastic Large Cell Lymphoma
What is breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)?
Breast implant-associated anaplastic large cell lymphoma (abbreviated as BIA-ALCL) is a rare form of T-cell lymphoma that occurs in some people who have had breast implants. It is not breast cancer but rather is a cancer of the immune system. The disease may affect a very small number of women who have received breast implants, primarily of the textured (rough) type. The lymphoma occurs in the scar tissue (fibrous capsule) that surrounds the implant and in more advanced cases may spread to lymph nodes that are near the breast.
BIA-ALCL generally progresses slowly. Usually, it can be treated by surgically removing the breast implant or implants and scar tissue. However, in rare cases when cancer spreads to the lymph nodes in other parts of the body, it may be fatal.
How common is breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)?
BIA-ALCL is a very rare condition. Fewer than 10 patients each year are diagnosed with this form of lymphoma. It is estimated that 10 to 11 million women throughout the world have received breast implants. The vast majority of cases of the disease have occurred in patients who have received textured implants, according to information from the FDA. The risk of developing BIA-ALCL ranges from one in about 1,000 to one in 30,000 for people with textured breast implants.
Symptoms and Causes
What are the risk factors for breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)?
- The exact cause of BIA-ALCL is not known, but risks seem to increase for implants with textured surfaces. It does not seem to matter if the implants are filled with silicone or saline.
- Textured implants may cause more inflammation than smooth implants. Possible contributing factors include reactions to implant particles, long-term allergies, genetic factors, or reactions to bacteria that grow on the implant’s surface. There seems to be no difference in the risk of BIA-ALCL among women who receive implants for breast augmentation or for breast reconstructive surgery.
What are the symptoms of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)?
If you experience symptoms that concern you in the area of your breast implants, try to remember that non-cancer issues are a much more likely cause. It is recommended that women perform monthly self-examinations to check for lumps or other issues. All implant related symptoms should be evaluated by a board certified plastic surgeon.
In cases of BIA-ALCL, symptoms like changes in the size or shape of the breasts appear well after the surgical sites are healed. One breast may appear larger than the other or look different in shape from the other (asymmetric). Usually, it takes at least two years after surgery for symptoms to emerge. However, the average length of time before symptoms appear is eight years.
Symptoms of BIA-ALCL may include:
- Swelling or fluid accumulation in the breast or around an implant
- Changes in the shape or size of the breast or breasts
Diagnosis and Tests
How is breast implant-associated anaplastic large cell lymphoma diagnosed (BIA-ALCL)?
Women who have received breast implants should report any new changes in the size or appearance of their breasts to their doctor and schedule a physical examination. Routine mammograms or breast X-rays will not detect this type of lymphoma. If your doctor suspects you might have breast implant-associated lymphoma, he or she may schedule diagnostic procedures that might include one or more of the following:
- Ultrasound or magnetic resonance imaging: Diagnostic imaging tests are performed to detect any fluid accumulation or lumps in the breast or swelling of lymph nodes.
- Needle biopsy: If imaging tests show there is a mass or excess fluid, a fine needle biopsy will be performed. During the procedure, a small amount of fluid is withdrawn from the breast with a needle. The sample is then sent to a lab for further testing.
- CD30 immune staining: A laboratory test is performed on the fluid that was obtained to detect the presence of CD30, a substance that occurs when T-cell lymphocytes are activated. If CD30 is present, it indicates that BIA-ALCL cannot be ruled out and further tests are required.
Management and Treatment
How is breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) treated?
If diagnostic tests confirm the presence of BIA-ALCL, the patient will be referred to an oncologist (specialist in treating cancer). The oncologist will determine the stage of the disease and recommend a treatment plan. Treatment will depend on the type and stage of the disease, the general health of the patient, her age, and other factors.
- Surgery: In most cases, surgical removal of the implant and the fibrous capsule around it (capsulectomy) is effective for treating the disease. Removal of some lymph nodes may also be necessary if they contain cancer cells.
- Chemotherapy: In rare cases where the cancer is more advanced or aggressive, patients may need to undergo chemotherapy in addition to surgery.
How can breast-implant associated anaplastic large cell lymphoma (BIA-ALCL) be prevented?
There is no way to prevent the disease, although early diagnosis and treatment can improve the outcome. Contact your doctor promptly if you have breast implants and experience symptoms such as new swelling, a new lump, breast pain, or changes in appearance. Discuss any concerns you might have with your doctor or plastic surgeon.
If you are planning to have cosmetic or reconstructive breast surgery, your plastic surgeon will help you make an informed decision about what type of implants are right for you.
Outlook / Prognosis
What is the prognosis for breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) patients?
The prognosis is very good for patients who are diagnosed in the early stages and undergo treatment. There is a very low chance of recurrence or death.
What are the general recommendations for women with breast implants?
All women with breast implants should have routine check-ups and breast MRIs as recommended. These follow-ups are usually recommended at 1-2 years to verify the integrity of the implants. Women should do their monthly self-examinations.
Women who have implants after undergoing reconstructive surgery should be examined yearly to monitor for breast cancer and for implant issues. Imaging tests may be recommended if indicated.