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BIA-ALCL, BREAST IMPLANT ASSOCIATED, ANAPLASTIC LARGE CELL LYMPHOMA

I have seen a few news reports about a form of cancer associated with breast implants. Mine have been in for 12 years – how can I make sure I don’t have cancer? Jill S Newport Beach, CA

I have personally dealt with thousands of breast augmentation patients but have personally never seen a case of BIA-ALCL (Breast implant associated anaplastic large cell lymphoma). This is a rare lymphoma, first reported in 2011, that has occurred in patients with textured breast implants. I am not aware of any cases of lymphoma associated with smooth walled implants. This is not a cancer of the breast tissue itself but a lymphoma (a type of cancer of the immune system) involving the scar envelope that the body naturally forms around any implanted device, called the capsule. The most common presenting symptom of BIA-ALCL is unilateral swelling of one breast years after implantation of textured implants, as a swollen lymph gland in the armpit or a lump in the breast. Recommended treatment entails a complete capsulectomy, implant removal and excision of any breast masses. All cases of BIA-ALCL with the disease limited to the capsule have been cured with a capsulectomy but rarely, the cancer may spread before the capsulectomy has been performed, and then chemotherapy will be required.

In the USA, approximately 300,000 breast augmentations and 150,000 breast reconstructions are performed annually. Since 2011, the FDA has collected 457 cases of BIA-ALCL, giving it an incidence in patients with textured implants of approximately 1 chance in 30,000 of contacting the disease (to put things in perspective, your chance of dying in an automobile crash in the USA today stands at 1 in 5,000 people). But since we almost exclusively use smooth walled implants, the important take away here is that this disease does not form in patients with smooth walled implants. Jill, in my opinion, even one case is too many, and if you have textured implants, I would recommend having the scar tissue removed and examined by a pathologist, and your implants exchanged to smooth, cohesive (i.e. gummy bear) gel implants. If your implants are of the smooth variety, your mammograms are normal and you are not having any problems with your breasts, I would electively have your implants exchanged before the twenty year mark of your implantation. At that time, it becomes very likely that your capsule will start developing sharp calcifications in the wall that will cause your implants to rupture. These calcifications occur from the implant rubbing against the scar tissue for a prolonged period of time, analogous to calcium deposits developing in a runner’s knee, a pitcher’s shoulder or a tennis player’s elbow. Please see these videos of calcifications that have occurred in old implants which we have removed: https://youtu.be/ARJxESI55Dw https://www.youtube.com/watch?v=_hHUlHGS8LE

This is an example of the inside of a capsule removed by Dr. Bunkis from a patient who had had these implants in place for 25 years. Note the bottom part of the capsule contains normal soft scar tissue. The top portion is calcified and has sharp edges which will always puncture the implant.

Finally, let me explain in a few words about implant surface differences. We have discussed the two options, smooth and textured implant surfaces. Originally, all implants had a smooth surface, analogous to a glass table top. In the 1980’s, scientists discovered that adding texture, similar to the surface of a fluffy rug, decreased the chance of capsular contractures from occurring. Over the years, the gold standard was the smooth walled implant but in a few cases where capsular contractures had recurred, textured implants were offered as an option.

Our best advice to all patients with breast implants would be to find out how long your implants have been in place and what type of breast implants you have in order to make an educated decision based on your risks. We offer complimentary consultations to anyone who would like their breasts checked, options reviewed and risks assessed. Please call 949-888-9700 for a consultation

By Juris Bunkis, M.D., F.A.C.S., Medical Director, Orange County Plastic Surgery, Newport Beach, CA

* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.