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ALCL from Breast Implants: Here’s the Facts
April 4, 2024
April 4, 2024
Getting breast implants can change a person’s life for the better. But in recent years, a rare lymphoma called Breast Implant-Associated (BIA) Anaplastic Large Cell Lymphoma (ALCL) has come to light that can be associated (at low risk) with some breast implants.
Here at Mode Plastic Surgery, we wanted to help break through the speculation and keep our community in the know. We sat down with Dr Aggarwal and talked through the big questions surrounding Breast Implant-Associated Anaplastic Large Cell Lymphoma ALCL (or BIA-ALCL) and the breast implants recall.
If you have any further questions please get in touch through our contact page or send us an email info@modeplasticsurgery.com.au.
Breast implants have been in the media recently due to a possible association with rare cancer called Breast Implant-Associated Anaplastic Large Cell Lymphoma. Only textured breast implants appear to be implicated, with smooth implants currently having no association with BIA-ALCL.
Simply put; Breast implant-associated ALCL is a rare type of cancer. It usually presents as a swelling of one breast due to an accumulation of fluid called delayed seroma. In rare cases it Breast implant-associated ALCL can take the form of a lump in the breast or armpit.
These symptoms occur on average 7.5 years after the insertion of implants. However, it can occur much sooner than this, as early as less than a year and late as 27 years after the operation as we have found in Australian and New Zealand records.
In the majority of cases of breast implant-associated ALCL, the patient can be cured by the removal of the implants and the capsule surrounding the implant. There are now over 700 cases reported and documented worldwide. While the disease has been very treatable in many there have been 33 worldwide recorded deaths, three of which were in Australia.
If you would like a numerical answer the literature on the subject suggests a wide variety from 1 in 3,000 to 1 in 80,000 risks of developing lymphoma from breast implants.
A recent study conducted in Australia in 2017 (Wilkinson et al PRS 2017) documented the risk per each type of implant, they found;
Before you read this data and panic, when put into perspective the risk of breast cancer is one in eight and you could argue that the risk of breast cancer in women with strong family history, previous breast cancer, is higher than this, and those with high-risk genetic mutations can have a risk of up to 80% of developing breast cancer.
This means in simpler terms this disease remains extremely rare, and the vast majority of women with breast implants in place (regardless of which type they have in) will never develop this disease.
At this stage, there is an investigation underway as new research is ongoing. Thus far there is a suggestion that it is likely that there is a multitude of factors causing the disease such as genes and genetic type, as mentioned previously using the textured specified higher risk implants, time in which a person has had their implants and finally, there is support for an ‘infective theory’. This theory describes a concept of minor contamination of the implant at the time the implant is inserted.
Allergan has been forced to suspend and recall their Allergan Biocell implants that were still ‘on the shelf’ and not yet implanted into patients yet.
The Australian Therapeutic Goods Administration (TGA) in July 2019 put on notice all textured breast implants and expanders, indicating they are reviewing all of their use in the Australian market. What this means is that there is a potential for a suspension of some or all of these devices.
It is important to note that this was simply a warning in response to BIA-ALCL, and the implant manufacturers were asked to respond to indicate to the TGA why their products should not be suspended. As of August 2019, there has been no proposed regulatory action made to suspend any other implants other than Allergan, in Australia.
Additionally please note that there has been no ban or suspension placed on any implants other than Allergan’s around the world.
If you develop a late swelling of the breast following breast implant you should inform us (or a doctor) immediately.
Dr Aggarwal will refer you for an ultrasound and at the same time, a fluid sample will be collected which will be sent off for a special marker of the disease (CD30).
You will not be required to undergo special imaging unless the marker returns positive from the ultrasound-guided aspiration.
Given the rarity of the disease, regular screening isn’t yet recommended by the TGA (Therapeutic Goods Administration). At Mode Plastic Surgery, we offer lifetime yearly checks of your implants and if, as with any procedure, you have any issues or concerns you should notify us to see Dr Aggarwal.
They say in life there is no such thing as a free lunch. If there is a ‘free’ implant check service, you need to question what is the catch?
A specialist who may not have put your implants in will not need to do anything if there is nothing wrong with your implants. However their time is worth something and they are accepting some medicolegal responsibility in reassuring you that there is nothing wrong.
In Dr Aggarwal’s opinion, the best place to go for reassurance would be the specialist who first put your implants in. Be very careful in going to a free implant check clinic, as you may get the advice to undergo complex surgery involving implant removal or replacement of your implants when you may not need this surgery.
If the specialist who originally put in your implants cannot give you the long term reassurance you need, or you require a second opinion, get in touch with a trusted Specialist Plastic Surgeon (and you may have to pay a consult fee to get this opinion, but think to yourself that a piece of mind may be worth the consult fee).
BIA-ALCL has occurred in women who have had breast implants for both cosmetic and reconstructive reasons, however currently there are no reports in Australia of BIA-ALCL occurring in women who have only ever had smooth implants. Only textured implants carry some risk for the disease (although the absolute risk is small).
Most cases are cured by removal of the implant and capsule surrounding the implant. If a patient was to develop BIA-ALCL on one side we would generally recommend removing the implants and capsules on both sides. All cases are discussed in a multidisciplinary setting with the involvement of a haematologist with experience with ALCL. Occasionally chemotherapy or radiotherapy is needed – usually when there is a solid lump (not just fluid-filled).
Nanotextured or smooth breast implants are not associated with BIA-ALCL (lymphoma). This means that smooth implants from suppliers like Mentor, Allergan or any other company do not cause lymphoma or any increased risk.
One of the newer manufacturers on the market is Motiva and their implants are nano-textured to provide some of the benefits of texturing. However they are classified by the TGA as smooth implants, and currently (like all other smooth implants) carry no associated risk of BIA-ALCL.
You can find more information about BIA-ALCL on the Australian Society of Plastic Surgeons website here.