BIA-ALCL (breast implant associated anapaestic large cell lymphoma) is a rare type of lymphoma that develops adjacent to breast implants. It usually presents as swelling of the breast or a lump in the breast or armpit, most commonly between 3 to 14 years after the implants are placed.
The Therapeutic Goods Administration has advised that of approximately 50 cases reported in Australia, most were cured by removal of the implant. Dr Sharp performs breast augmentation surgery in accredited hospital facilities and upholds the highest standards of infection control, to reduce the risk of bacterial biofilm contamination associated with the disease. He has also committed to the Macquarie University’s 14 Point Plan to reduce breast implant infection and utilises the Australian Breast Device Registry.
The following outlines up to date advice from the Australian Society of Plastic Surgeons on BIA-ALCL and provides a helpful guide, through the most commonly asked questions regarding this disease.
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.
What causes BIA-ALCL?
- Australian and New Zealand Plastic Surgeons - in partnership with local and international research organisations - are at the forefront of investigating this disease and are working proactively with the government to keep them informed.
- Bacteria has been identified within the lymphoma and around implants in affected breasts; there is evidence that a long-term inflammatory response to the presence of the bacteria is one of the factors that may cause BIA-ALCL
- Genetic factors may also be involved for some women; investigations into the disease are continuing to improve clinical understanding.
What is breast implant associated - anaplastic large cell lymphoma (BIA-ALCL)?
- BIA-ALCL is not the same as breast cancer; it developed in the fluid around the breast implant and is contained by the fibrous capsule around the implant.
What are the symptoms?
- The symptoms of BIA-ALCL most commonly include persistent swelling or a lump in the breast or armpit
- Symptoms most commonly develop between 3 to 14 years, with the most common occurrence around 8 years after implantation.
- The swelling is because fluid has accumulated around the implant; the lymphoma develops around the breast implant in the fluid, and is not in the breast tissue itself.
What are the risks of developing BIA-ALCL?
- Approximately 50 patients have been identified in Australia as having this disease, making it very rare. The low rates also makes it difficult to be certain about the absolute risk of developing the disease.
- The risk is believed to be around 1 in every 5000 women who have breast implants. This is a much lower risk than other cancers - such as breast cancer - which carries a 1 in 8 risk for women.*
- *Update March 2019: an updated risk assessment released in March 2019 in the Plastic and Reconstructive surgery Journal showed that the risk of developing BIA-ALCL with the type of microtextured implants we use is 1 in 89,000. This differs from the 1 in 2,800 risk that some other, cheaper, implant types carry, making our implants some of the safest in the world.
Are some women, or implants, more at risk than others?
- Based on current available data, it is uncertain as to whether texture implants of different types carry different risks; however we do know that to date, no cases of BIA-ALCL have been reported in women who had only smooth implants.
- It is not possible to predict who will develop BIA-ALCL; it has occurred in women who have breast implants for both cosmetic, and also for reconstructive, reasons - and in women who have both saline and silicone implants.
How is BIA-ALCL diagnosed?
- Ultrasound is the first diagnostic tool used; if fluid is detected, this is removed and tested for BIA-ALCL
- If BIA-ALCL is confirmed, MRI and PET/CT scans may be performed to help provide an indication of the stage of present disease.
- Mammograms are not useful in diagnosing BIA-ALCL
What is the treatment of BIA-ALCL?
- Most cases are cured with the removal of implants, along with the fibrous capsule around the implants.
- The majority of patients don’t require any further treatment.
- Less commonly, further treatment such as chemotherapy and/or radiation may be required.
Should breast implants be removed preventatively, or ‘just in case’?
- Breast implants are not lifelong devices and in general all will need to be removed or replaced at some stage.
- The most common reason for implant removal or replacement is capsular contracture, implant migration or rupture.
- Without symptoms or signs of BIA-ALCL, routine implant removal is not required unless there are other implant concerns.
Are there ways to make breast implant surgery safer?
- There is growing evidence that suggests bacteria are associated with complications of breast implant surgery as all as the risk for capsular contracture - which doesn’t lead to cancer.
- Infection control standards are extremely important in breast surgery to ensure the best outcomes, and specialist plastic surgeons are expertly trained to ensure the highest standards of patient safety and lowest risk of infection.
- A 14 point plan has been developed for surgeons to help reduce the risk of bacteria growing around the implant. Dr Sharp has committed to this plan.
What should you do if you’re worried about BIA-ALCL?
- Contract the surgeon who performed your breast augmentation; if you can’t contact them, ask your GP for a referral to a specialist plastic surgeon.
- If you have breast swelling associated with breast implants, you may need a referral to have an ultrasound; if required, some fluid may be removed for testing. Most breast swelling that occurs after breast implants is not due to BIA-ALCL, but it should be excluded.
Can new breast implants be inserted after a BIA-ALCL diagnosis?
- Current treatment protocols indicate that the removal of both breast implants - along with the capsule around them - is required because a small number of cases have been diagnosed bilaterally (on both breasts at the same time).
- Implants are not replaced during this operation
- Smooth implants may be reinserted 12 months after the treatment of BIA-ALCL if the disease is no longer present, however the safety of this strategy is still being investigated
I’m considering breast implants but am also concerned about BIA-ALCL - what should I do?
- Discuss the risks and benefits of the surgery with your specialist plastic surgeon, including the risks of BIA-ALCL
- Discuss with your surgeon the steps that s/he takes to reduce the risk of biofilm formation
- Implant selection must take into account the risks and benefits of specific implant choices - implant selection will vary from patient to patient
- Breast implants aren’t for life; women with breast implants should always consider that they will require revision or replacement of the breast implant at some time, and as with all surgery, these future surgeries carry costs and risks.
- Therapeutic Goods Administration (TGA) website
- Safer Breast Implants website
- Australian Breast Device Registry website
- Australian Society of Plastic Surgeons advisory