Dr. Mahabir - Recent media reports regarding breast implants and a rare form of cancer

March 5, 2019

 

You may have heard or seen recent media reports regarding breast implants and a rare form of cancer. The FDA recently updated information regarding this Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL). Dr. Raman Mahabir, the Vice Chair of the BIA-ALCL committee of the American Society of Plastic Surgeons answers your questions on Breast Implant Associated ALCL (BIA-ALCL).

 

Q: What is BIA-ALCL?

A: BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma) is an uncommon T-cell lymphoma* that to date has only been reported in patients that have had a textured breast implant. BIA-ALCL is not a cancer of the breast tissue itself but of the scar tissue that the body naturally forms around a breast implant – called the capsule. When caught early, it may be curable in most patients. There is however a spectrum of the disease that ranges from fluid collections in the breast to capsular tumors to lymph node involvement and rarely distant metastatic disease. Ongoing research continues to strive to better understand and define BIA-ALCL.

*Lymph cells are part of the body's normal immune system that helps to protect us from foreign material. A lymphoma is cancer of the lymph system. Lymph nodes are glands in many locations in the body and are part of the lymph system.

 

Q: What are the symptoms of BIA-ALCL?

A: The most common symptom of BIA-ALCL is fairly marked swelling of the breast (sometimes double in size) that develops after years of having a textured breast implant. You may notice fluid collecting around the implant or noticeable breast asymmetry. It can also present as a lump in the breast or armpit, hardening of the breast or an overlying skin rash.

 

Q: What is the risk of developing BIA-ALCL?

A: We are aware of almost 700 cases worldwide and 265 cases in the US. The best estimates of the lifetime risk for BIA-ALCL is 1:1000 to 1:30,000. The risk is higher with textured implants that have a higher surface-area, such as Allergan’s Biocell, than with lower surface area, such as Mentor’s Siltex. However, all brands of textured implants have had cases of BIA-ALCL. At this time there are no reported cases of a patient that has only ever had a smooth implant developing BIA-ALCL. BIA-ALCL in both cosmetic and reconstructive cases and with both saline and silicone implants.

 

Q: What did the latest FDA statement say in regards to BIA-ALCL?

A: The February 2019 statement was mainly an update on the number of reported and cases and stressed that all BIA-ALCL cases be reported to the PROFILE registry for detailed tracking of cases. The statement also affirmed that if a breast implant patient is not experiencing symptoms then there "is no need to change your routine medical care and follow-up."

 

Q: Is BIA-ALCL a major concern?

A: We want patients to be aware of the risk. Though the risk is small, patient safety is our primary focus, and we strive to educate and inform our patients and the public about the symptoms and risk of BIA-ALCL.

 

Q: How does this impact those with breast implants?

A: We advocate that all women, including those with breast implants follow their normal routine