BIA-ALCL Breast Implant News Update

SEPTEMBER 2023: BIA-ALCL UPDATE

Breast implant-associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a rare cancer that can be effectively treated if detected early.

The Australian Society of Plastic Surgeons encourages women with breast implants to monitor for changes in their breast, and promptly contact their doctor if they notice any of the following:

• Lumps
• Pain
• Swelling
• Skin changes

There are also reports of cancers including squamous cell carcinoma and other various lymphomas developing in the scar tissue around breast implants. This is different from BIA-ALCL, and there is some confusing around the types of cancers associated with breast implants. Not all implants carry the same risks. So it is important for patients undertaking breast augmentation surgery to know the currently available facts regarding the implants they are having placed.

• Squamous cell carcinoma is a cancer of squamous cells
• Lymphoma is a cancer of lymphatic cells, but is different to BIA-ALCL
• They are not breast cancers
• The cancers occur in association with breast implants and have been found in the capsule of implants
• Most cases occur years after the insertion of implants

What is the risk of BIA-ALCL or BIA-SCC occurring?

The most accurate risk published to date shows BIA-ALCL a risk of 1 in 35,000 for micro textured implants. The risk associated with BIA-SCC and other cancers is currently unknown. The Australian Society of Plastic Surgeons states that “the FDA is aware of less than 20 cases of BIA-SCC and less than 30 cases of various cancers associated with breast implants”. As at December 2022, the TGA is aware of one case in Australia.

The Therapeutic Goods Administration, who oversea the use of prosthesis in Australia, updated its information regarding BIA-ALCL this month, and its website is a must-read for anyone considering breast augmentation surgery. It reiterates that the “aetiology of BIA-ALCL appears complex and multi-factorial” with the exact cause unknown. Where implant-related cancer occurs, inter-related factors have been proposed that include:

• the use of textured implants (the more highly textured, the higher the risk)
• bacterial contamination at the time of surgery to cause inflammation
• patient genetic predisposition
• time for the process to develop

A review of BIA-ALCL cases reported to the TGA, up until the end of 2021, indicates the following risk rate:

• polyurethane-coated implants have an estimated risk of 1 in 1,800. This kind of breast implant is no longer available in Australia
• macro-textured implants have an estimated risk of 1 in 2,400. This kind of breast implant is no longer available in Australia
• micro-textured implants have an estimated risk of 1 in 18,000.
• there are no confirmed cases of BIA-ALCL in Australians that have only had smooth implants.

How is BIA-ALCL or BIA-SCC diagnosed and treated?

When BIA-ALCL is suspected, imaging by ultrasound and CT scan or MRI of the breast is performed. A mammogram is not used for detecting the disease.

Most cases of BIA-ALCL are cured by surgery with the removal of the implant and the surrounding capsule. If there are implants in both breasts then both implants are removed even if symptoms only appear on one side. If there is a solid lump or the cancer has spread, chemotherapy, radiotherapy or additional surgery may be required.

If BIA-SCC is suspected, the current advice is to perform breast ultrasound and MRI with and without contrast. If disease is confirmed, a PET-CT and fine needle aspiration (FNA) with cytology testing is also performed. Evidence currently suggests that the treatment that produces the best outcome is explantation with total capsulectomy.

What are the symptoms or BIA-ALCL or BIA-SCC and do I need to get my implants removed?

Symptoms of BIA-ALCL include swelling, pain and lumps. Anyone with breast implants – of any kind – who experiences these symptoms should see their GP and request a referral to their original plastic surgeon. The TGA also now imposes very strict reporting requirements, ensuring that all cases of BIA-ALCL are tracked, so authorities can work with up-to-the minute information regarding any cases in Australia.

Unless you have symptoms of BIA-ALCL or other implant complications, medical authorities do not recommend the precautionary removal of implants.

As with all aspects of your medical care, it’s important to be informed; every patient should know which type of implant they have, and safety store this information somewhere they can reference later, if required. Your surgeon should also register your implants with the Breast Implant Device Register, so even if you forget the name of your surgeon years or decades down the track, or lose your implant information, you can always track it down through this independent register. The register also enables researchers to collate data, so by registering your implants, your surgeon is contributing to large-scale data collection and helping to track overall implant safety.

BIA-ALCL recap: if you want breast implants but are concerned about BIA-ALCL, what can you do to reduce the risk?

1. Choose a qualified plastic surgeon that has taken the Macquarie University 14 Point Pledge to ensure best practice methods are used when your implants are placed

2. Ensure your surgeon uses high quality smooth or ‘nano’ textured implants (zero risk) or ‘micro’ textured implants (very low risk)

3. Ensure your implants are registered with the Breast Implant Device Registry

4. Check your breasts monthly (whether you have implants or not) and if you see or feel any changes, speak to your GP or surgeon

And most importantly, discuss any concerns with your surgeon prior to your operation. They will support you in choosing the right implant for your body shape, breast goals and overall feelings about implant risks.

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The above information is general in nature and does not constitute indivdual medical advice. Online forums and social media are not reliable sources of surgical advice or information. Speak to your surgeon directly if you have any concerns or queries. 

MAY 2021 UPDATE 

When performed by a qualified plastic surgeon using best practice methods, breast augmentation remains a procedure that carries low rates of morbidity and mortality.

However, media reports today have reinvigorated discussion about breast implant related lymphoma – specifically, highly textured implants. These ‘macro’ textured implants are no longer available in Australia. This is not new news, and does not relate to updated evidence or recently-released research.

Quoted by Channel 7 News today, a Better Heath Victoria spokesperson said: “the level of risk depends on the type of implant you have. People who have highly textured implants seem to be at the greatest risk (between one in 2500 and one in 25,000)”.

“This risk significantly decreases with a decrease in texturing of the implant.”

The TGA also advises that: “the evidence available at present indicates that while causes are likely to be multi-factoral (sic) BIA-ALCL is more likely to occur in implants with a greater surface area and roughness of their wall”.