A Discussion of BIA-ALCL

Breast Implant-Associated Anaplastic Large Cell Lymphoma

I have decided to include a discussion of BIA-ALCL because although it is exceedingly rare, it has gotten a lot of media attention lately.  This is a very slow-growing breast tumor that is associated with both bacterial contamination of a very rare bacterium, Ralstonia, as well as a textured implant.  As of this update in 2019, there have been 457cases in the U.S, and worldwide there have been 681 cases since it was discovered in 1997 (ref.1). It appears that the risk is 33 patients for every million textured implants. (ref.2). It usually presents as an obvious fluid collection or a mass around some implants eight to ten years after surgery. The survival rate is 94% at three years after treatment, which is often just the removal of the capsule and the implant. The risk of developing BIA-ALCL is the same among breast cancer and cosmetic patients, silicone and saline patients.

Personally, 95% of the implants I currently use in my practice are smooth, not textured.  I am also very meticulous in my sterile technique, using antibiotic and antiseptic rinses in the pocket that would make bacterial growth more unlikely.  Nonetheless, for several years, I did prefer textured implants especially for breast augmentation because of the lower risk of encapsulation so it possible that you may have textured implants.  I feel strongly that once I’ve placed an implant in one of my patients, they need to stay in my practice. I will always want a copy of a patient’s mammogram report and I will encourage my patients to continue to follow up with me because what we know about breast implants will continue to evolve.  I will obviously be the best person to keep my patients informed.

References:

1 – Global Adverse Event Reports of BIA-ALCL, An International Review of 40 Government Authority Databases, Plastic and Reconstructive Surgery, May 2017
2 – U.S. Epidemiology of BIA-ALCL, Plastic and Reconstructive Surgery, May 2017