BIA-ALCL (breast implant associated anaplastic large cell lymphoma)
BIA-ALCL (breast implant associated anaplastic large cell lymphoma) is an unusual cancer that the FDA linked to breast implants in 2011. The disease is a rare cancer of the immune system and is not a breast cancer. In most cases once the cancer is identified, the cancer is cured by removing the implant and the capsule around it, but if not detected early the cancer can be lethal. As of July 2019 there have been 573 cases and 33 deaths from the cancer.
The lymphoma is rare given that millions of women have breast implants. According to the American Society of Plastic Surgeons in 2017, more than 300,000 women had breast enhancement surgery with implants and about 100,000 had implants placed for reconstructive purposes. BIA-ALCL has been seen in women with cosmetic and reconstructive implants. The main symptoms of this unusual cancer consist of the development of swelling or fluid accumulation around the implant years after the implant was placed.
The contents of the implant, saline or silicone, are not a factor in the development of the lymphoma. The covering of the implant’s outer surface of the implant seems to be the key. Textured implants, which have a slightly roughened surface that adheres to the surrounding soft tissues, are closely associated with the development of the majority of BIA-ALCLs.
The FDA recently recalled Allergan implants from the U.S. market. The surface of the Allergan textured implants appears to be associated with the majority of the BIA-ALCL patients in the U.S. and this fact led to the recall.
Dr. Duffy has used almost exclusively Mentor implants since he has been in practice. The incidence of BIA-ALCL is lower in this company’s textured implants. He also uses Mentor smooth silicone implants which has an even greater reduction of BIA-ALCL incidence. These issues and potential complications are always part of his informed consent discussion in all patients considering breast implants.
Lastly, if patients are candidates, Dr. Duffy’s first choice is always autologous reconstruction with the patient’s own tissue. Typically this is a DIEP flap. This always provides the most durable and natural result without the risks and complications associated with breast implants.