Breast-implant associated anaplastic large cell lymphoma, or BIA-ALCL, is a rare cancer that starts in the fluid or scar tissue that forms directly around an implant. It is not actually breast cancer, but rather a cancer of the immune system known as non-Hodgkin’s lymphoma. BIA-ALCL has been reported with both silicone gel and saline implants. It occurs most frequently in patients with textured implants.
Although very rare, BIA-ALCL occurs in patients who have textured breast implants placed for cosmetic or reconstructive purposes. This cancer is associated only with one type of breast implant, called a textured implant. Textured implants have a textured surface, opposed to smooth implants (which do not).
A new worldwide report recorded a total of 573 unique BIA-ALCL cases, including 33 patient deaths. Of the 573 cases, 481 reported having an Allergan breast implant at the time of diagnosis. According to the FDA, the risk of BIA-ALCL with Allergan branded textured implants is approximately six times the risk of BIA-ALCL with textured implants from other similar manufacturers.
It is important to understand the signs and symptoms associated with BIA-ALCL so that you can be proactive in your own care. The most common sign of BIA-ALCL is fluid around the implant (seroma), which typically occurs many years after the implant was originally placed. From this, the breast usually appears and feels swollen, painful, and may also become misshapen. Similarly, tightening due to scar tissue around the implant (capsular contracture) is another common sign of BIA-ALCL. Less common signs of BIA-ALCL include tumors in the breast skin, as well as enlarged lymph nodes in the armpit. These signs do not mean that a patient has BIA-ALCL. However, if you do have any of these symptoms, it’s important to consult with Dr. Tanna.
If it is determined that BIA-ALCL is a concern, Dr. Tanna will order an MRI, PET scan, and/or ultrasound, as well as take tissue and fluid simples in order to comprehensively evaluate your breasts. In the unlikely case you are diagnosed with BIA-ALCL, treatment typically involves surgery to remove the implant and the capsule around the implant (en bloc capsulectomy). Although removal of textured implants is typically the only treatment necessary, there have been cases where patients have required chemotherapy and/or radiation therapy. This is most common in late diagnosis of BIA-ALCL.
BIA-ALCL seems to develop exclusively in patients who have, or have had, textured breast implants (rather than smooth implants). In asymptomatic patients with textured implants (without BIA-ALCL), there is no evidence on how implant removal has an effect on reducing risk of developing BIA-ALCL in the future. Lack of data creates a challenge for patients and surgeons to determine the best course of action with textured implants. It is important to consult with Dr. Tanna to determine what is best for you.
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