Breast Implant Safety
Newport Beach

Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

BIA-ALCL stands for breast implant-associated anaplastic large cell lymphoma. It is a very rare cancer that has been confirmed only in patients with breast implants that have a rough (textured) surface. BIA-ALCL is not a cancer of the breast tissue. It is located in the scar tissue/the capsule that naturally forms around the implant.

BIA-ALCL is often curable if diagnosed and treated early, but there have been women whose initial diagnosis reveals the disease has already spread (metastasized) to their armpit lymph nodes or other parts of their bodies. In addition to capsulectomy and removal of the implants, women with advanced disease may require chemotherapy, radiation therapy or even stem cell transplantation. Unfortunately, there have been some deaths from this disease so self checks and following your physician’s recommended imaging schedule are very important for the early detection of swelling, a new breast/armpit lump or changes to your breast skin so you can seek treatment immediately.

Understanding Your Risk

As of July 2019, literature reports various estimates for the incidence of BIA-ALCL. These estimated incidence rates range from a high of 1 per 3, 817 patients to 1 in 30,000. (Clemens et al, 2017, Loch-Wilkinson et al, 2017, De Boer et al, 2018)

Importantly, BIA-ALCL has been identified in patients with all types of textured implants and both breast cancer reconstruction and cosmetic patients.

To date, there are not any confirmed BIA-ALCL cases that involve only a smooth implant, but the medical records of many women diagnosed with BIA-ALCL did not specify whether their implants were textured. Currently, it is not possible to test for who is at risk of this disease.

Knowing the Symptoms

Common symptoms include unexplained breast enlargement, pain, asymmetry, lump in the breast or armpit, overlying skin rash, hardening of the breast or a large fluid collection. For any patient experiencing these or any symptoms, they should see their doctor for evaluation.

Considering reconstruction with implants?

Breast cancer patients considering implant reconstruction should discuss the benefits and risks of different types of implants with their physician. There are many breast implant options such as smooth, textured, round, shaped, saline and both liquid and solid silicone. A physician may suggest a certain implant shape, surface and fill to achieve an optimal reconstruction while minimizing potential complications. BIA-ALCL is an emerging risk of textured implants and patients should be aware when choosing the implant that is right for them.

Have you developed symptoms?

If you think you have developed the symptoms of BIA-ALCL, you should see your physician to be evaluated with a physical exam and further testing.

1. Schedule a follow-up appointment with your treating physician to discuss any concerns you may have about your breast health or implants.
2. Following a physical examination, patients with BIA-ALCL symptoms may receive an ultrasound or magnetic resonance imaging (MRI) of the symptomatic breast to evaluate for fluid or lumps around the implant and in the lymph nodes.
3. If fluid or a mass is found, patients will require a needle biopsy with drainage of the fluid to test for BIA-ALCL. This fluid will be tested for CD30 immune staining (CD30 IHC) performed by a pathologist. Testing for CD30 IHC is required to confirm a diagnosis or rule out BIA-ALCL. Fluid collections ruled out by CD30 IHC for BIA-ALCL will be treated as typical seromas by a physician. Specimens not testing for CD30 may miss the diagnosis of BIA-ALCL.

Have you been diagnosed with BIA-ALCL?

Receiving a diagnosis of cancer is inevitably frightening and emotional. Everyone’s experience is different, but when found early, BIA-ALCL is curable in most patients.
ASPS endorses BIA-ALCL guidelines established by the National Comprehensive Center Network (NCCN), which defines diagnosis and treatment based on proven methods to treat the disease.

Step-by-step treatment of BIA-ALCL

1. When a woman is diagnosed with BIA-ALCL, her physician will refer her for a PET/CT scan to look for any disease that may have spread throughout the body. Any spread of the disease determines the stages, which is important for determining treatments and predicting how successful that treatment may be.
2. Newly diagnosed patients will be referred to an oncologist for evaluation of BIA-ALCL, staging of the disease and treatment planning.
3. For patients with BIA-ALCL only around the implant, surgery is performed to remove the breast implant and the scar capsule around the implant.
4. Lumps in the armpit may be a disease that has spread to the lymph nodes or may still be a normal enlargement of the lymph nodes. Testing of the lymph nodes may be performed with a needle biopsy or with surgery to remove a lymph node for testing. Additional tests may sometimes include blood tests and a bone marrow biopsy.
5. Some patients with advanced cases that have metastasized, or spread to distant parts of the body, will require further treatment. This may include chemotherapy and in rare cases include radiation therapy and/or stem cell transplant therapy.

After treatment

For women with early-stage cancer, following removal of the disease, patients are commonly followed for two years with imaging tests for three to six months. Disease reoccurrence is rare after surgical removal for early disease, but can occur and it’s important to detect recurrences as soon as possible.