Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): Your Frequently Asked Questions, Answered

For so many women, getting breast implants is a life-changing procedure – offering a chance to love your body more than ever. 

But in some unfortunate cases, breast implants can have complications, and these complications may require implant removal. 

One rare condition that has recently been highlighted is Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). This is a very rare but potentially dangerous cancer (lymphoma) that can form around particular types of textured breast implants. 

The Food and Drug Administration (FDA) has required all future breast implants to have a warning label addressing their link to BIA-ALCL. Allergan, in particular, has recalled an entire line of breast implants because of this disease. These actions made many women worry about their risk of developing this relatively unknown condition. 

To help you make a guided decision in choosing your breast implants, here are the most frequently asked questions about BIA-ALCL.

Table of Contents

What is BIA-ALCL?

 

Breast Implant-Associated Anaplastic Large Cell Lymphoma is a rare type of cancer commonly associated with textured breast implants. It is a cancer of the immune or lymphatic system connected to the scar tissue created after a breast implant is placed inside the body. 

In every person, the body forms a scar tissue, known as the capsule, around the implant’s entirety. Studies show that this scar tissue is at risk of forming fluid collections, capsular tumors, and other lymphoma types with textured breast implants. 

Though it is rare for this type of slow-growing cancer to metastasize, some patients choose to undergo textured breast implant removal to prevent or cure the disease.

What are the Symptoms of BIA-ALCL?

 

Most patients that develop BIA-ALCL have no obvious signs or symptoms. They only learn about the lymphoma from other tests. 

The disease progresses slowly, with an average onset of roughly eight years after the textured implant has been inserted into the body. There is almost no evidence of BIA-ALCL in less than two years. In some patients, it may even take nearly 30 years to develop.

For those experiencing signs and symptoms, these patients report one or any of the following:

• Lump in the breast or armpit’s lymph nodes
• Breast hardening
• Pain in or near the breast
• Breast enlargement
• Fluid buildup
• Skin rash over the breast

In case you suspect having BIA-ALCL, call your plastic surgeon. 

Your doctor will ask you to get an ultrasound, which detects fluid collection, capsular mass, or lymph node swelling. He will take a liquid sample for further testing. 

You will then be subjected to a Cell Block Cytology, which will determine if BIA-ALCL is the likely cause of your discomfort. 

All good surgeons will recommend you do these procedures before your doctor decides to take a surgical approach to the challenge. 

Are Textured Implants Safe?

 

BIA-ALCL is still considered rare enough that textured implants remain an acceptable choice for breast augmentation procedures. 

If you currently have or are considering getting textured implants, rest assured that the incidence rate of BIA-ALCL is considered very low. The FDA does not believe that you need to take any action or even avoid textured implants as the risks don’t outweigh the benefits. 

However, it does help to know about the signs and symptoms of BIA-ALCL so that you can pay better attention to abnormalities and have an idea of what to watch for and consider should you feel something wrong. 

Studies on Textured Implants

 

Only 230 cases of BIA-ALCL have occurred in the US, with only 570 found around the world. With millions of textured implant procedures performed, the incidence rate is very low. In fact, other breast augmentation complications are more common than BIA-ALCL. 

The FDA is aware of the link between BIA-ALCL and textured implants. They also agree with the medical consensus that this cancer should be considered and treated as lymphoma and that further research is needed to learn more about its causes and risk factors. 

They recommend that patients should be made aware of the risk of BIA-ALCL when choosing textured implants. As long as a patient is not experiencing symptoms, she does not need to change how she receives medical care. 

European review boards have had similar findings to the FDA. Implant removal is considered an option for those concerned about their risk, but the FDA has noted that the condition responds very well to treatment and is slow-moving. 

While the word “cancer” is certainly a scary one and can cause issues when left untreated, the FDA does not see the need to pull textured breast implants from the market.

Even though 21 deaths worldwide have been linked to BIA-ALCL, the reasons for their deaths were mostly due to coming in very late after the disease has metastasized, their body unable to handle the treatment, or their surgeon failing to perform BIA-ALCL removal correctly.

Saline vs. Silicone Textured Implants

 

Studies show no known difference in BIA-ALCL risk between silicone and saline implants, whether you get a cosmetic breast augmentation or breast reconstruction.

However, there appears to be a BIA-ALCL association with textured breast implants with rougher surfaces, including those with more aggressive texturization. 

But this isn’t something you should worry about because very few of these highly texturized breast implants are still in production. Most have long since been retired from modern cosmetic surgery, thus reducing your risk further.

Check out the list of textured implants the FDA recalled due to increased BIA-ALCL risk.

The Link Between Allergan Implants and BIA-ALCL

 

There are three major breast implant manufacturers in the US – Allergan, Mentor, and Sientra. 

Allergan breast implants – specifically their BIOCELL line – have been wholly recalled because they have one of the largest surface areas among all US-made breast implants. And as previous studies showed, the risk of developing BIA-ALCL increases with a textured implant’s surface area.

Sientra and Mentor don’t make breast implants with large surface areas, and the same goes for Allergan’s other models (Microcell and Natrelle implants). Thus, the number of BIA-ALCL cases associated with Mentor implants is significantly lower than that of the BIOCELL implant line.

Because of the recall, Allergan provides a two-year warranty that allows patients to receive a smooth implant for free as a replacement for their recalled textured implant. 

But since the FDA does not recommend breast implant removal, Allergan won’t pay for the surgery itself. It will only pay for the smooth implants. 

Explantation surgery will still be considered elective and need to be paid out of pocket. 

The Case with Smooth Implants

 

On the other hand, smooth implants are not considered risk factors in BIA-ALCL. But this does not mean that smooth implants are safer than textured implants, as it also poses risks like other breast implant types. 

Like Dr. Siamak Agha, most surgeons contact plastic surgery patients who already had textured implants to let them know about the risk. They also make sure that all new and current patients stay informed.

Are You at Risk for BIA-ALCL?

 

Based on numerous studies, the only risk factor for BIA-ALCL appears to be the use of textured implants, especially those with aggressive texturization. It also seems to be more common among older people. There may also be a genetic component for some.

However, it is estimated that BIA-ALCL only occurs in 1 out of 1,000 or even 1 in 30,000 patients with textured implants. 

According to the American Society for Plastic Surgeons, about 50,000 patients who underwent breast augmentation or breast reconstruction still elected to use textured implants. After all, there is currently no known evidence that those at high risk for breast cancer are also at greater risk for BIA-ALCL. 

How is BIA-ALCL Treated?

 

If you’ve been diagnosed with BIA-ALCL, you have many medical options available, including:

• Breast implant removal
• Capsulectomy (removal of scar tissue)
• Breast lump excision

In rare cases, cancer may progress to or through the lymph nodes, which may require you to undergo chemotherapy.

If you undergo explantation and removal of the scar tissue, surgical excision can be curative. However, the capsule can grow back. That’s why it’s crucial to work with a skilled plastic surgeon capable of removing the entirety of the implant and capsule surrounding it.

As long as the BIA-ALCL is completely removed, the prognosis for this type of cancer is excellent.

How Can You Prevent BIA-ALCL?

 

The most important thing is to make sure that you’re paying attention to any signs and symptoms of the disease, as stated above.

Routine appointments with your physician along with a mammogram, when recommended by your doctor, are traditionally all you need. There is no current evidence that additional screening beyond the recommended minimum doctor visits is required for BIA-ALCL. Likewise, the FDA doesn’t recommend implant removal.

Still, if you are uncomfortable or worried about the idea of having textured breast implants, Dr. Agha recommends the following options:

• Have both implants removed
• Excise the capsule around the implants entirely
• Replace with smooth breast implants
• Use your fat instead of the explanted implant
• Use no implant or fat and undergo a breast lift

If you have one of the implants listed on the FDA recall notice, but you’re not experiencing any symptoms, you don’t need to have them removed. Unnecessary breast implant removal carries its risks and is not considered mandatory given how rare the disease is, how slow it progresses, and how treatable it is. 

However, there are reasons that patients may want to consider implant removal – for example, if the implants were not providing the results you wanted, or you believe they’re important to remove or replace for lifestyle reasons. 

In these situations, Dr. Agha can talk to you about your options to see what makes the most sense for your body. 

Medical insurance will not pay for elective implant removal or replacement. But if you are diagnosed with BIA-ALCL, your medical insurance may pay for all or part of the surgical removal. 

Get More Information About BIA-ALCL from The Aesthetic Centers

 

Whether you are considering implant removal or simply want to learn about your BIA-ALCL options, schedule a consultation with Dr. Agha today to help you make the right decision.