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.
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Dr Dona Discusses ALCL
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
Less commonly, It can present as a lump in the breast or armpit
It usually develops 3 to 14 years after the insertion of breast implants.
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.
It is a rare condition, with expert opinions estimating the published risk of BIA-ALCL at between 1-in-2,800 and 1-in-86,000.
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 developing lymphoma (not-implant related) 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 vast 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?
Because BIA-ALCL is rare, experts do not recommend removal of breast implants where there are no problems with the implant.
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
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