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 very rare, it has received a lot of media attention lately. This is a very slow-growing breast tumor that is associated with both bacterial contamination and a very rare bacterium, Ralstonia, as well as a textured implant. As of this writing in 2018, there have been 257 cases in the U.S. and 656 cases world-wide 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 around an implant approximately 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.  The FDA does not recommend removal and replacement of textured implants at this time. 

Personally, almost all the time, the implants I currently use in my practice are smooth, not textured, although I have used more textured implants in the past.  I am very meticulous in my sterile technique, using antibiotic and antiseptic rinses in the pocket that would make bacterial growth more unlikely. 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.

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