Breast Implant Associated Anaplastic Large Cell Lymphoma is an uncommon and treatable type of T cell lymphoma that can develop around textured breast implants. It is not a cancer of the breast tissue itself. The disease has been associated with both silicone and saline implants that are textured. It has nothing to do with what is inside the implants (silicone or saline), it is related to the surface texturing of the implant shell.
The time lag between implant insertion and diagnosis averages 9.75 years.
No case has been documented when the patient has only had smooth implants.
The more aggressive texturing may have an increased risk for development of BIA- ALCL . The company Allergan, which manufactures Natrelle textured implants with boicell and have a more aggressive texturing, has a higher rate of BIA-ALCL. Allergan has voluntarily taken their textured implants off the market.
This does not mean a recall to remove textured implants already implanted. The risk is still very rare. It is also hypothesized that the texturing and a very rare bacteria in the implant pocket, leads to the incidence of BIA –ALCL. The bacteria is not destroyed by normal antibiotic washes, but can be eliminated by washing out the breast pocket with a betadine solution or a hypochlorous acid solution.
Patients with textured implants should be diligent on regular self assessments and regular follow up with their plastic surgeon. Of course patients can elect to have their Allergan textured implants removed or replaced earlier than they may have been planning to. As many of you may recall the recommendation from our office is replacing implants around 15 years.
The majority of patients with BIA-ALCL present with a delayed seroma (fluid collection) and their breast(s) may appear larger . A small sample of the fluid surrounding the implant can be sent in for testing. Other much less common symptoms can include a breast lump, skin rash, fever, night sweats, and swollen lymph nodes.
The treatment is bilateral total capsulectomy and implant removal. If the disease has progressed, chemotherapy or radiation may be needed. If the symptoms are ignored and one does not remove the implant and the entire capsule, the progression of the disease can be deadly. So please remember for my textured implant patients, it’s imperative you follow up with me on a yearly or every other year basis! There will be no charge for your office visit!
The risk of BIA – ALCL in micro textured implants is believed to be 1 in 80,000. To put this in perspective, the risk of breast cancer in a woman’s lifetime is 1 in 8 women or a 12% risk during our lifetime!
Lisa Taylor MD FACS
