News update: BIA-ALCL

Information about ALCL breast implant

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 104 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 TGA and 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?


  • EAustralian 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.
  • EBacteria 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
  • EGenetic 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)?

  • EBIA-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?

  • EThe symptoms of BIA-ALCL most commonly include persistent swelling or a lump in the breast or armpit
  • ESymptoms most commonly develop between 3 to 14 years, with the most common occurrence around 8 years after implantation.
  • EThe 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?

Are some women, or implants, more at risk than others?

  • EBased 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.
  • EIt 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?

  • EUltrasound is the first diagnostic tool used; if fluid is detected, this is removed and tested for BIA-ALCL
  • EIf BIA-ALCL is confirmed, MRI and PET/CT scans may be performed to help provide an indication of the stage of present disease.
  • EMammograms are not useful in diagnosing BIA-ALCL

What is the treatment of BIA-ALCL?

  • EMost cases are cured with the removal of implants, along with the fibrous capsule around the implants.
  • EThe majority of patients don’t require any further treatment.
  • ELess commonly, further treatment such as chemotherapy and/or radiation may be required.

Should breast implants be removed preventatively, or ‘just in case’?

  • E Breast implants are not lifelong devices and in general all will need to be removed or replaced at some stage.
  • EThe most common reason for implant removal or replacement is capsular contracture, implant migration or rupture.
  • EWithout 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?

  • EThere 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.
  • EInfection 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.
  • EA 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?

  • EContact the surgeon who performed your breast augmentation; if you can’t contact them, ask your GP for a referral to a specialist plastic surgeon.
  • EIf 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?

  • ECurrent treatment protocols indicate that the removal of both breast implants – along with the capsule around them – is required.
  • EImplants are not replaced during this operation
  • ESmooth 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?

  • EDiscuss the risks and benefits of the surgery with your specialist plastic surgeon, including the risks of BIA-ALCL
  • EDiscuss with your surgeon the steps that s/he takes to reduce the risk of biofilm formation
  • EImplant selection must take into account the risks and benefits of specific implant choices – implant selection will vary from patient to patient
  • EBreast 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.

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