Cancer associated with breast implants: Overblown concerns about ALCL?

Author: Michaela Petrovič

Breast augmentation is undoubtedly the most commonly requested esthetic and plastic surgery procedure. An estimated 11 million women around the world have breast implants. Safety is therefore a key concern, and implants are one of the most tightly controlled medical products available. Women with breast implants may become alarmed at the news of a rare type of lymphatic cancer that is associated with breast implants. We have prepared some information to put your mind at rest.

What is BIA-ALCL?

BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma) is a large-cell lymphoma that appears in connection with breast implants. Breast lymphoma is not classified as breast cancer, but as a cancer of the lymphatic system in the breast area with a very good prognosis for recovery. Based on cases thus far, ALCL occurs about 6-8 years after implantation.

This type of lymphoma is not described only with textured implants, but also with smooth implants, expanders, alveolar implants, and even around osteosynthetic materials used in treating broken bones. BIA-ALCL is associated with all implant manufacturers.

How does malignant lymphoma occur?

The breast implant is placed into a pocket created by the operator, usually under the pectoral muscle. Over time fibrotic scar tissue forms around the breast implant, a process called capsulation. One of the suggested causes of ALCL is a chronic inflammation of the breasts caused by bacterial contamination, chronic irritation from the implant texture or a genetic predisposition.

breast augmentation

Implant placement after breast augmentation.

Symptoms of ALCL

According to the latest findings, BIA-ALCL appears 6-8 years after implantation in a sudden, painful swelling of one breast. However, swelling can also be caused by other diseases.

Diagnosis and treatment of ALCL

Diagnosis is made on the basis of cytology, where fluid is drawn from the breast – laboratory tests then confirm or rule out the presence of ALCL. 

It must be stated that this is an extremely rare and treatable disease.

Treatment involves complete removal of the implant and capsule. In early stages of the disease, patients do not need any further treatment. If caught at a later stage, removal is followed by further treatment, including chemotherapy if the disease has spread to the lymph nodes.

ALCL cases around the world

Truly an extremely rare disease, ALCL is estimated to appear in between 1:50,000 and 1:300,000 women who have undergone breast augmentation. Since 1997, a total of 457 cases have been documented around the globe, with 9 reported deaths. (Source: FDA report dated March 22 2019).

For comparison, a two-day trip to New York City carries much more risk than the chance of developing this extremely rare, treatable disease, as the President of ISAPS described the risks associated with BIA-ALCL in his announcement addressed to plastic surgeons.

Well-known plastic surgeon Dennis Hammond describes how breast implants are strictly controlled in a short video.

 

Are textured implants a higher risk?

The information currently available indicates that this type of lymphoma is associated with the use of textured implants from all manufacturers. The authorities responsible for control and approval of drugs and medical materials are busy investigating known cases. However, the causes of ALCL come from multiple factors and texture is not the primary cause of this lymphoma. A number of experts are discussing the possibility of a genetic predisposition.

Allergan implants – facts and myths

Shortly before Christmas, the President of ISAPS (the International Society of Plastic Surgery) released a statement for patients setting a number of misconceptions straight.

One of those misconceptions is the suspension of sales of Allergan textured implants in Europe. Suspension, not a ban, as some media outlets have sensationalized it. This suspension is not due to new findings about these breast implants, as some have erroneously reported, but due to not extending CE certification in Europe.

This is because Allergan did not provide the required data on time. It is currently working on providing the data and renewing the certification. Allergan continues to be sold elsewhere in the world with no restriction and it holds the highest level of FDA safety certification. Allergan smooth implants are also still in circulation without restriction.

Ask your plastic surgeon about ALCL

You can ask about ALCL at your consultation and any future check-ups. The essential information about this extremely rare disease should be given by your doctor during the consultation prior to breast augmentation as well as in the patient consent form, along with all other risks associated with breast augmentation.

breast augmentation
Every woman should take care of her breasts. Regular self-examinations and regular ultrasounds or mammograms are the key to early detection.

ALCL and disease prevention?

International associations of plastic surgeons and regulatory authorities do not recommend removing implants without a confirmed case of ALCL or as a preventive measure. Just a handful of confirmed cases of ALCL exist. Women with breast implants who notice sudden changes in the breast area, especially swelling or puffiness, should see their operating physician for a checkup.

No screening for BIA-ALCL has been put in place yet. The best prevention is still based on performing regular self-checks. Regular ultrasounds and mammograms should be routine for women who have undergone breast augmentation and other procedures, mainly due to the risk of rupture of the implant.

We continue to keep close tabs of new developments about ALCL. 


Sources:
BAPRAS (British Association of Plastic Reconstruktive and Aesthetic Surgeons)
ISAPS
www.lymphoma.org
https://associationofbreastsurgery.org

Updated: 2019-04-18

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Breast Augmentation - Breast Implants - News

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