Breast Implant-Associated Anaplastic Large Cell Lymphoma
This is an update to the information I posted on my website in 2019 concerning BIA-ALCL.
Allergan or McGhan Biocell textured implants were released in 1996 and pulled from the market in 2019.
They were used because they had a lower incidence of encapsulation and malposition and enabled a teardrop or shaped implant to stay in place.
BIA-ALCL (Breast Implants Associated Anaplastic Large Cell Lymphoma) is an unusual malignancy that is associated with heavily textured implants. It was initially thought to be extremely rare but with the passage of time is now classified as an “unusual” occurrence. As of May 2024, there are 434 cases of BIA-ALCL in the United States and 1,352 world-wide. The risk is currently estimated to be somewhere between 1 in 300 and 1 in 1000 patients.
The presentation tends to be fluid collection or a mass and the likelihood of developing a tumor increases over time. The risk factors are the length of time the implants have been in, older patients and patients with a history of Breast Cancer. Fortunately, the tumor is very curable if diagnosed early.
The course of action for patients with textured implants remains controversial. The FDA and the American Society of Plastic and Reconstructive Surgeons advise that surgery is not necessary at this point, but this recommendation may change as the incidence seems to be slowly increasing. They also do not recommend against surgery, just that it is not mandatory.
The surgical options are: removing the implant, exchanging it for a smooth implant, a total capsulectomy (removing the scar tissue around the implant) with or without replacement. Currently most surgeons feel that a capsulectomy is a significantly invasive procedure that is higher risk than the implants themselves and not warranted, considering the current low number of BIA-ALCL patients. Allergan will give you a free set of implants, but unfortunately it is not helping to cover the cost of the surgery otherwise.
We do not have enough long-term data for me to guide you definitively in this decision. My current practice tends to be removal with implant exchange since the risk of BIA-ALCL tends to increase the longer the implants have been in, with a biopsy of the capsule if it appears unusual in any way. You do not have to do anything surgically, but please continue to have regular mammograms if you have had a breast augmentation, and an ultrasound or MRI every two or three years if you have had a breast cancer diagnosis after mastectomy. I can help order these
tests.
I will continue to post updates on BIA-ALCL as new information emerges. Please do not hesitate to come in for consultation or contact me for further information at (804-320-8545).