Is BIA-ALCL breast cancer?

No, BIA-ALCL is not breast cancer.

ALCL is a cancer of lymphatic cells and a form of Non-Hodgkin’s Lymphoma. It has been described in all parts of the body well before breast implants existed, and has occurred in the breast without any implant present.

BIA

-ALCL is a form of lymphoma that occurs in association with breast implants, and to date exclusively with exposure to textured implants (no reported cases with smooth implants alone). It occurs in women who have had implants for both cosmetic and reconstructive indications.

How long after surgery does it occur?

It takes an average of 7-10 years after implant insertion before it develops.

What causes it?

There are thought to be four inter-related factors:

• Textured implants (with a higher risk for high surface area textures)
• Bacterial contamination at the time of surgery to reach a threshold to cause inflammation
• Patient genetic predisposition
• Time – for the process to develop

How does it appear?

The commonest presentation is a fluid swelling around the breast implant, in the space between the implant and breast implant capsule. This is called a seroma. The diagnosis of the tumour is made by examination of the seroma fluid.

This will present as a swollen breast.

Can it be treated?

Early stage disease, which is by far the most common presentation, is cured with surgery alone. Disease which has spread through the capsule, forming a mass, or which has spread to local lymph glands carries a worse prognosis and may require more extensive treatment.

Is it common?

Conservatively there are 30 million women (60 million implants) in the world with textured implants. There are 388 independent confirmed case of BIA-ALCL. 55 confirmed cases in Australia. There are only 12 deaths worldwide, with many of these occurring before treatment principles were better understood. 3 of these deaths were in Australia.

In comparison, the risk for Australian women of breast cancer is about 1 in 8. These are separate diseases.

Should I have my implants removed or replaced?

Implants are not life devices and possibly will need revision in due course.

The most common reasons for revision are: capsular contracture, implant migration, poor aesthetic result, size change and rupture. Different types of implants perform differently, give different outcomes and have different relative risks of these complications.

Routine implant removal is not indicated for asymptomatic women with breast implants including textured implants.

Should I have my implants checked?

All women with implants who note changes in their breasts should seek advice. The overwhelming majority will not have BIA-ALCL.

Dr Perkins, have any of your patients had BIA-ALCL?

I have not personally had a case of BIA-ALCL in my practice.

I now only use microtextured implants (low surface area texture) unless there is a very specific indication not to, and the reason to use other than a microtextured implant would be made clear and discussed preoperatively with the patient.

Anti-bacterial strategies are used to mitigate against the risk of bacterial contamination of implants at the time of implant insertion. These steps have been shown to reduce the risk of capsular contracture and re-operation. They may also reduce the risk of developing BIA-ALCL. My longstanding practices conform to these strategies.