Breast implant associated-anaplastic large cell lymphoma (BIA-ALCL) is a very rare cancer that can be effectively treated, when detected early. Recent media reports may have caused confusion amongst women who have - or are considering getting - breast implants for augmentation or reconstruction. This post seeks to clarify what we know about BIA-ALCL.
Last year 1.5 million implants were inserted worldwide. The number of people having breast implant surgery in Australia has risen by more than 1,000% since 2005, from approximately 4,000 per year - to over 40,000. More people have implants now than ever before, and so we would expect the number of people reporting complications now to be proportionally higher than what they were 5, 10 or 20 years ago.
The TGA has been posting updated information about BIA-ALCL since 2011. As of August 2017, we haven’t seen one case of BIA-ALCL in our clinic, nor amongst our patients.
What is BIA-ALCL?
It is a cancer of lymphatic cells; a form of Non-Hodgkin’s Lymphoma (not breast cancer).
What causes BIA-ALCL?
Media focus has concentrated predominantly on implants, but there’s actually 4 unifying factors that contribute to an increased risk of BIA-ALCL:
• Textured implants with a high surface area texture
• Bacterial contamination at the time of surgery
• Patient genetic predisposition
• Time for the process to develop
How long does BIA-ALCL take to develop?
An average of 7-10 years after implant insertion. But women who have breast implants should regularly check their breasts for changes at any stage after breast augmentation surgery - most of all for actual breast cancer, which occurs in 1 in 8 women, whether they’ve had augmentation surgery or not.
What is the treatment and prognosis?
Early stage disease is curative with surgery alone. Advanced disease requires chemotherapy. Disease which has spread through the capsule and formed a mass - or which has spread to local lymph glands - has a worse prognosis. There have been 12 deaths world wide; 3 of these were in Australia.
How common is BIA-ALCL?
It is a very rare cancer. Patients who have the implants in place that Dr Sharp predominantly uses (see below) have a 1 in 60,000 chance of developing ALCL.
If I have textured implants, do I need to have them removed?
If you have no symptoms, you do not need to have your implants removed.
Do some implants have a reduced risk?
Yes; as mentioned above, according to the current available data, the chance of developing ALCL if you have the textured cohesive gel implants that Dr Sharp predominantly uses, is 1 in 60,000. For other brands of implants, this rate can be as high as 1 in 4,000.
What are the symptoms of BIA-ALCL?
The common presentation is fluid swelling around the breast implant and in the space between the implant and breast implant capsule – called a ‘late seroma’. The diagnosis of the tumor is made by examining the seroma fluid.
Is BIA-ALCL breast cancer?
BIA-ALCL not breast cancer. Breast cancer affects 1 in 8 Australian women
How common are textured breast implants?
There are approximately 60 million textured breast implants implanted in women. Of these, there have been only 388 independent confirmed cases of BIA-ALCL. 55 of these were in Australia.
Which breast implants does Dr Sharp use?
It is important to know the name of your breast implants, however TGA regulations prevent us from naming the brand publicly. Dr Sharp’s patients receive their breast implant identifying details (including brand name, style, size and lot/reference number) after their surgery. If you can’t locate this information, we are able to provide the implant details if you send us an email or call us on 3202 4744. The implants Dr Sharp uses are backed by substantial clinical data demonstrating safety. The evidence continues to support the safe use of these implants, which have the lowest rate of BIA-ALCL.
What does Dr Sharp do to reduce his patients’ risk of developing BIA-ALCL?
ALCL has been associated also with bacterial infection at the time of surgery. Dr Sharp upholds the highest hygiene standards when implanting. He only performs breast augmentation surgery in accredited hospitals. He has committed to the Macquarie 14 Point Plan which is a series of steps that can be taken by surgeons to reduce infection risk for implant cases. The names of the surgeons committed to these risk reduction measures in their operative techniques are publicly available here.
If you have had breast augmentation surgery and have any concerns, it’s important to:
- Promptly discuss any concerns you have with your treating surgeon.
- Be informed about the type of implants you have had placed; your surgeon should be able to provide you with this information.
- The Australian Society of Plastic Surgeons and the Australian Society of Aesthetic Plastic Surgeons urges women with breast implants to be vigilant in monitoring for any changes or swelling in their breasts and to contact their doctor if this occurs.
BIA-ALCL is a very rare disease, but as always, it is important to know your breasts, monitor them and if you notice changes, promptly speak to your surgeon – we encourage regular self examination and prompt investigation of any concerns. We always set aside consultation time for urgent concerns, to ensure our breast augmentation patients are offered a consultation with Dr Sharp as quickly as possible if they are worried about their implants.
If you are considering breast augmentation surgery and have any concerns:
- Ask your surgeon as a first point of contact; with so much information online, it’s easy to consult forum chatter before your surgeon! Your plastic surgeon is being kept up to date with the latest facts and research, so they have the most accurate information available.
- Don’t proceed with surgery if you have doubts or concerns. Breast augmentation surgery isn’t medically required or something you have to do in a fixed time frame. It’s important to feel 100% comfortable and confident before proceeding with any cosmetic procedure, so don’t hesitate to postpone or cancel your plans if you are unsure of, or uncomfortable with, the risks.
- Book additional consultations with your surgeon if you need more information.