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BIA-ALCL

Quick Facts:

Information provided by the Australian Society of Plastic Surgeons (ASPS) 12/05/2017

  • BIA-ALCL is a rare form of non-Hodgkin’s lymphoma.
  • When diagnosed early and managed properly it is curable.
  • There is a global collaboration of researchers investigating the cause of this disease and it is a rapidly developing area.
  • Without symptoms or signs of BIA-ALCL routine implant removal is not required unless there are other concerns.

WHAT IS BREAST IMPLANT ASSOCIATED-ANAPLASTIC LARGE CELL LYMPHOMA (BIA-ALCL)?

A rare form of Non-Hodgkin’s lymphoma that develops adjacent to breast implants

BIA-ALCL IS NOT BREAST CANCER

BIA-ALCL develops in the fluid around breast implants and is usually contained by the fibrous capsule around the implant. It does not develop in breast tissue.

WHAT ARE THE SYMPTOMS OF BIA-ALCL?

The most common presentation is as a persistent swelling of the breast due to fluid collecting around the implant

It can present as a lump in the breast or armpit

It usually develops 3 to 14 years after the insertion of breast implants and most commonly around 7 to 8 years

WHAT IS THE RISK OF DEVELOPING BIA-ALCL?

No woman who has only had smooth breast implants has developed BIA-ALCL.
The risk of developing BIA-ALCL with textured or polyurethane implants depends upon the type of implant.

High surface area textured implants have demonstrated a risk of around one in 4000 compared with one in 60,000 for low surface area textured implants
For perspective, the risk of breast cancer is close to one in eight and the life risk of a woman living to 84 years of lymphoma is one in 50

ARE SOME WOMEN MORE AT RISK THAN OTHERS?

BIA-ALCL has developed patients having breast implants for cosmetic and reconstructive purposes

BIA-ALCL has developed in patients with both silicone and saline implants

There appears to be genetic factors that aren’t fully appreciated that effect the incidence of this disease and ongoing research is examining this connection

All women who have developed BIA-ALCL have had exposure to textured or polyurethane breast implants

HOW IS BIA-ALCL DIAGNOSED?

If a patient develops a persistent fluid collection around an implant she should be investigated with ultrasound and if fluid is identified this will be removed and tested for BIA-ALCL

Specific tests are asked for using immunohistochemistry – specifically a concern regarding ALCL needs to be indicated and specific immunohistochemistry for CD 30 receptor protein (CD30+) and negative for anaplastic lymphoma kinase gene translocation (ALK-)
Most fluid collections will be benign seromas and not BIA-ALCL however it does need to be excluded

Mammogram is not useful

MRI and PET CT scans are performed to help stage the disease and plan surgery once a diagnosis is established

WHAT IS THE TREATMENT OF BIA-ALCL?

The majority of cases are cured with the removal of implants and the fibrous capsule around them from both breasts (there is a rare incidence of bilateral disease)

All women treated without a delay to diagnosis and with appropriate management principles have resulted in complete remission

SHOULD WOMEN WITH BREAST IMPLANTS BE SCREENED ROUTINELY FOR BIA-ALCL?

Expert opinion at this time is that women without symptoms or changes to their breasts do not need regular ultrasound scans

Breast implants are not lifetime devices: if there are changes in your breasts associated with breast implants and especially if there is
generalised swelling or a lump women should have a breast examination and this may need to be investigated further accordingly

SHOULD BREAST IMPLANT BE REMOVED JUST IN CASE?

Breast implants are not lifetime devices and in general all will need to be removed or replaced at some point

The most common reasons for implant removal or replacement remain capsular contracture, implant migration and implant rupture
Without symptoms or signs of BIA-ALCL routine implant removal is not required unless there are other concerns

DO WE KNOW THE CAUSES OF BIA-ALCL?

The main “theory” at present is that it is caused by bacteria.
There is a global collaboration of researchers investigating the aetiology of this disease and it is a rapidly developing area

ARE THERE WAYS TO MAKE BREAST IMPLANT SURGERY SAFER?

There is accumulating evidence that bacteria are associated with other complications of breast implant surgery as well

These include the risk for capsular contracture and acute infection, however neither of these lead to cancer.

Infection control standards are extremely important in breast surgery to ensure best outcomes and Specialist Plastic Surgeons are expertly trained to ensure the highest standards of patient care and lowest risk of infection.
Plastic surgeons have recently been reminded of the basic principles to be undertaken during surgery to minimise the bacterial load around the implant.

Dr Dona has always adhered to these general principles for all his implant cases throughout his career. These steps have been demonstrated to also significantly reduce the incidence of capsular contracture.

WHAT SHOULD YOU DO IF YOU ARE CONCERNED ABOUT YOUR BREAST IMPLANTS?

Contact your surgeon or your GP for a referral to a Specialist Plastic Surgeon
If you have swelling of the breast associated with a breast implant you may need a referral for an ultrasound to remove some fluid for testing and this will be able to determine if BIA-ALCL is present

Specific investigations need to be requested during the analysis of the fluid
Most women with a swelling of their breast associated with breast implants will have a benign seroma and not BIA-ALCL but it still needs to be excluded

CAN BREAST IMPLANTS BE RE-INSERTED WHEN BIA-ALCL IS TREATED?

Current treatment protocols indicate that the treatment of both breast implants with the capsule around them is required because a small number of cases have been diagnosed on both sides at the same time
Implants are not replaced at the same time

Smooth implants have been reinserted in a small number of patients after a period of delay for early-stage disease finally adequate treatment of BIA-ALCL without disease progression however the safety of this management plan is still being investigated

WHAT SHOULD I DO IF I AM CONSIDERING BREAST IMPLANTS?

Women who are considering breast implant surgery should discuss the risks and benefits of the procedure with their specialist plastic surgeon including the risk of BIA-ALCL which should form part of the consent process.

There are different implant types available an implant selection needs to take into account the risks and benefits of specific choices
Implant selection will be different from one person to the next
Breast implant are not lifetime devices and women with breast implant should all consider that they will require revision or replacement of their breast implants at some time in the most likely reasons will be capsular contracture, implant migration, implant rupture or size change

WHERE CAN I GET FURTHER INFORMATION?

https://www.tga.gov.au/breast-implant-associated-cancer-or-bia-alcl

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