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Anaplastic Large-Cell Lymphoma (ALCL)

Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

BIA-ALCL is a rare and treatable lymphoma which has been found to develop around some implants. The following are some known facts and the Australian Government’s Therapeutic Goods Administration (TGA) are regularly updating information on this topic as research continues:

  1. It is a rare cancer of the lymphatic cells and a form of Non-Hodgkin’s Lymphoma which is related to bacterial biofilm contamination of implants
  2. BIA-ALCL in not a breast cancer
  3. It usually involves swelling due to fluid accumulation around the breast, usually 3-14 years after the operation to insert an implant. Less commonly it may present as a lump in the breast or armpit
  4. If you notice swelling or a lump you should seek medical attention
  5. Most cases are cured by the removal of the implant and capsule
  6. Implants are not a lifetime device and on average will be removed 10-15 years after implantation
  7. A breast ultrasound should be requested to identify fluid. Any fluid will then need to be tested by a laboratory to confirm diagnosis.
  8. A mammogram is not helpful to diagnose BIA-ALCL
  9. MRI and CT scans may also be required
  10. No Australian cases have been reported in women who have only smooth implants
  11. Dr Craig Layt adheres to the 14 point plan which reduces infection risk and is a technique to minimise the incidence of BIA-ALCL

The TGA is working together with consumer groups, surgeons and the Australian Breast Device Registry (ABDR) in relation to statistics and information regarding  BIA-ALCL. The TGA is regularly updating information on BIA-ALCL and can be viewed at Therapeutic Goods Administration.

The recent media information has discussed the link with BIA-ALCL, a rare lymphoma. BIA-ALCL is NOT breast cancer. Breast cancer is cancer of the breast tissue and the risk is 1 in 8 women(with or without implants). BIA-ALCL is a lymphoma, a rare cancer of the immune cells, present between the textured implant surface and the capsule or scar formation around the implant. It is rare, with approximately 100 cases reported in Australia.

Research to date indicates BIA-ALCL is due to the exposure of bacteria at the time of surgery or recovery and the interaction between the bacteria hiding within the texturing of the implant and the genetic makeup of the individual causing the cells to react by changing the immune cells into a lymphoma. Some textured surfaces have a higher risk due to the increased texturing of the surface and area for the harbouring of the bacteria. A recent Australian and New Zealand research paper indicated the risk of BIA-ALCL with textured implants is 1 in 86, 000 for Mentor textured implants and 1 in 3, 300 for Allergan textured implants. This data is always being updated.

BIA-ALCL presents as a large fluid build-up around the implant causing the breast to appear significantly larger. It has occurred between 3 and 14 years post implantation, with the average being approximately 8 years. The treatment if a breast with an implant presents with swelling of the breast is to ultrasound and test any fluid for ALCL. It is important to note that even if you have swollen breasts it is very unlikely it is ALCL and the majority of tests come back negative for ALCL. In the rare cases where ALCL is confirmed, the Breast Implant, fluid and capsule will be removed and this usually solves the problem. The important information is to act on any unusual or different behaviour or feel of your breasts. There is no reason to consider removing your implants if you have no symptoms.

Whether you have implants or not, self-examining your breasts and armpits in the shower or bath regularly and when you visit your GP is an important monitoring for everyone with or without Breast Implants. Knowing what feels normal and what feels ‘different’ in your breasts is important whether you have implants or not. If something feels ‘different’ or unusual consult your GP or surgeon promptly and have the changes assessed. An ultrasound will be able to identify if there is fluid and have the appropriate tests done to exclude BIA- ALCL.

As mentioned, the theory from the research that has been conducted worldwide so far has suggested that the presence of BIA-ALCL requires 3 things:

1. A genetic risk factor,
2. A bacteria to be present and
3. A textured surface for the bacteria to harbour itself and cause the inflammation and lymphoma.

The infection control standards of a surgeon and the accredited surgical facility are an important part of minimising the risk of BIA-ALCL and decreasing the risk of the bacterial growth. Dr Layt has always performed Breast Augmentation in accredited theatre complexes with an emphases on specific techniques and practices to minimise bacterial infection. The 14 Point Plan has been the technique Dr Layt, and other Plastic Surgeons, use due to the high level of training and education that they engage in, to minimise risk of any infection. In another international research paper , the study looked at 42, 000 Allergan Biocell and Silimed Polyurethane Breast Implants performed by Plastic Surgeons and included a 10 year follow up. This study found no BIA-ALCL in the 42, 000 textured breast implants.

The TGA, implant companies, consumer groups and surgeons are not recommending to remove textured implants but for all patients to monitor changes in their breasts and to be proactive if they see changes.

Implants are not lifetime devices and will be required or desired by the patient to be replaced or removed at some time. Dr Layt continues to consult on breast revision surgery. This can be removal and replacement of the implant, breast implant removal and capsulectomy and in some cases combining a breast lift with these procedures.

We are introducing a clinic where you can have a clinical breast implant check and screening with an in office ultrasound. Ultrasound is very useful for assessing if fluid is present and for obvious issues with the implant integrity. MRI continues to be the Gold Standard of imaging breasts.

Please keep a lookout for our social media as we are also working on regular posts regarding breast topics and also on self-examining your breasts. We feel this is an important part for every person, implant or not, to be proactive in self-examination of your breasts.

If you have any concerns about your breast implants please contact your GP and book an appointment with your surgeon. If you have a presentation of swelling then an ultrasound should be performed to investigate.