BIA-ALCL — What is it and Should I be Concerned?
Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a treatable and rare cancer of the immune system that develops in patients with breast implants. In the United States, an estimated 225 cases have been reported although the number of actual confirmed cases is approximately 25.
The first case of BIA-ALCL was reported in 1997. The FDA has studied the matter and issued two statements, in 2011 and 2016, affirming the safety of breast implants while noting a “possible association of ALCL and implants.”
The position of the American Society of Plastic Surgeons is that breast implants continue to be safe. The risk of a patient developing ALCL is rare and estimated at 2 cases per 1,000,000 patient-years. Furthermore, the ASPS does not recommend additional screening or health care monitoring for patients with breast implants and states that patients do not need to change their routine medical care and follow up.
The incidence of ALCL continues to be studies and we await the final results of the CARE Study although current estimates range from 1 in 30,000 to 1 in 4,000.
Patients who have undergone breast augmentation or reconstruction should be aware of swelling or fluid collections associated with breast implants which develop after the primary incisions, the original surgical site, have healed. Fluid that develops around a breast implant may be aspirated, a minimally invasive procedure, and the fluid submitted for analysis for CD30 marker.
Patients who are diagnosed with BIA ALCL generally have an excellent prognosis.
In my practice, and based on the case series of BAI ALCL, I recommend using smooth non-textured implants for all aesthetic breast augmentation. I do consider using textured implants in cases of reconstructive surgery as a strategy to minimize the chance of Capsular Contracture and maintaining implant position.
We adhere to the No-touch Technique of breast implant insertion after the pocket is created for a number of reasons. This is due to the idea that bacterial contamination of the implant during surgery contributes to capsular contracture and has been proposed as a cause of BIA ALCL.
If you note that you are developing fluid collections around your breast implant after healing from surgery is complete, you must consider the possibility of BIA ALCL as it remains a small but real possibility.
For more information on this important and treatable condition, please reference the ASPS web site at www.plasticsurgery.org.
P. Pravin Reddy, MD is a Board Certified Plastic & Reconstructive Surgeon and a member of the American Society of Plastic Surgeons.