July 29, 2019

Breast Implants and BIA-ALCL

woman looking at breast implants

This past week, breast implants were in the headlines: “Breast Implants—Recalled Worldwide.” The New York Times, as well as other news outlets, ran numerous articles about this event.

The headlines were in response to Allergan’s recent recall of Biocell textured implants and tissue expanders. Allergan issued this recall based on concerns that textured implants are associated with a very rare type of cancer called BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma) that can occur in and around the tissues around a textured implant.

What is Breast Implant-Associated Anaplastic Large Cell Lymphoma – BIA-ALCL. BIA-ALCL?

BIA-ALCL is not a cancer of the breast tissue, but rather is a unique type of lymphoma specifically associated with breast implants (typically textured) and usually presents 6-10 years after a woman has received those implants. It is believed to be a type of inflammatory reaction in response to the implants in certain individuals. It most frequently presents as a sudden increase in the size of a breast due to a collection of fluid although it can also present as a mass or rash.

How Common Is BIA-ALCL?

BIA-ALCL is relatively rare. To date, 573 cases of BIA-ALCL have been described worldwide, which includes 33 deaths related to this specific type of ALCL. This is out of approximately 25 million women in the world with breast implants. Current estimates are that women have a 1:3800 to 1:30,000 risk of developing BIA-ALCL. In contrast, the risk for a woman to develop breast cancer is 1:8. Furthermore, no cases of BIA-ALCL have been confirmed in women with smooth implants.

How Is BIA-ALCL Treated?

Fortunately, if caught at the first sign of swelling, BIA-ALCL is curable by removing the implant and the connective tissue capsule that forms around the implant.

What Does the Recall Mean?

The recall is of unused Biocell devices – those that are sitting on the shelves. It also means that these devices can no longer be placed in patients. However, currently, given how rare BIA-ALCL is, the U.S. Food and Drug Administration (FDA) does not recommend removing textured implants for prevention only.

What Should You Do?

Signs and symptoms of BIA-ALCL include swelling, pain, asymmetry, or lumps or masses. Though gradual changes in breast shape do occur with time and gravity, any changes that seem abnormal, sudden, or strange should prompt a call to our office during business hours so we can schedule you to come in for a check-up. The vast majority of the time, these findings do not represent anything serious; however, it is always smart to address concerns early.

It is important that all women remember that breast implants are not lifetime devices. This means that most women will require removal and replacement at some point after the first 10-15 years. As part of your breast health, you should perform monthly self-breast exams and examine your breasts for any changes, obtain annual mammograms after age 40, and follow up with your plastic surgeon every year to monitor your implants. In this manner, we can continue to monitor you and your implants for any changes.

Your health and safety are and always have been the most important thing to me, as your plastic surgeon. Please feel welcome to call the office with questions or concerns. If you currently have a silicone breast implant, textured or smooth, please ensure you have a regular follow-up visit scheduled with Dr. Bajaj.