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

Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is a very rare type of T-cell lymphoma, a type of cancer impacting the immune system. This specific form of cancer develops in the capsule of scar tissue that forms after implant surgery. This capsule is normal, and tends to be very soft and natural feeling. Dr. Khanna states it’s important to know that it is “not breast cancer but blood cancer in the breast.”

In some women, this cancer, which is not a form of breast cancer itself but rather a blood-based cancer, forms within the tissue that adheres to and forms within the capsule surrounding the breast. Researchers have found that it is most likely to occur when the implant is textured rather than smooth.

While all people with breast implants should know about BIA-ALCL, it’s important to know it’s a rare type of cancer. The Food and Drug Administration states that as of June 2023, they have had 1264 recognized cases of BIA-ALCL reported. Of those reported cases, just 3 to 5% of people with this cancer have experienced it spreading to other areas of the body. It is clear, then, that there is a low risk and an even lower risk of developing life-threatening cancer if the condition is observed and treated.

However, this is also a very limitedly understood condition. The number of cancers reported could be low. More so, researchers are still working to understand why it forms in some women and why it does not in others.
Specifically, all BIA-ALCL cases have been diagnosed in people who have textured implants. Dr. Khanna has discontinued implanting these products as a result of this higher risk.

Symptoms of BIA-ALCL can be hard to detect in some people. However, one of the most important and common symptoms is the rapid development of fluid in one breast or around one breast implant. In some situations, this can occur within a matter of hours or a few days, often leading to swelling or the development of a lump next to the surface of the implant or extending into the armpit area.

BIA-ALCL symptoms may develop 7 to 10 years after the breast implant. It may occur sooner than this.

Some women also experience skin rash, fever, enlarged lymph nodes, and unexplained weight loss. In situations where multiple symptoms occur, or there is swelling in both breasts, it is still beneficial to reach out to a doctor to be examined for large cell lymphoma BIA cancer.

Core signs warranting contacting a doctor include the following:

• Breast enlargement often on one side more so than the other
• Pain development in the area of the swelling
• Fever or unexplained illness, including swelling of the lymph nodes
• Lumps that develop in or around the armpit or breast
• Hardening of the breast

The sooner this cancer is detected, the sooner it can be removed. This can make it critical for individuals to seek care any time they begin to notice a change in their implants or the tissues surrounding the area.

To diagnose BIA-ALCL, doctors will provide a physical examination. From there, additional tests may be requested, including an ultrasound, biopsy of the area, and lab testing. Typically, an MRI will provide information about fluid buildup around the implant, which may then encourage doctors to take a sample of that fluid using a needle aspiration. This fluid is then examined. Doctors should test for CD-30, a specific type of protein found in lymphoma cells, including those that make up BIA-ALCL. If found, another test for anaplastic lymphoma kinase (ALK) is then completed.

If you have textured breast implants and you are concerned about the risk of developing BIA-ALCL due to any of the symptoms mentioned here, consult your doctor right away.

Treating BIA-ALCL is often done with the support of an oncologist, who will complete further evaluations to create a treatment plan. This may include the completion of a PET scan to determine the locations of cancer in the body.

Surgical removal is often recommended. This procedure typically involves the removal of the implant and the surrounding capsule of scar tissue where any masses are present. For some people, this is the only necessary step.

According to the National Comprehensive Cancer Network (NCCN) guidelines for treating BIA-ALCL, this is the recommended treatment. With en-bloc capsulectomy, which removes the breast implant and surrounding scar tissue in a single section, as well as surrounding tissue, and complete surgical excision, the survival rate is very high, and an event-free survival is possible. In those who have not had cancer spread to other areas, the survival rate is as high as 95%.

One of the largest risks for developing BIA-ALCL stems from having textured breast implants. While researchers are not sure what the connection is, the rough surface of these implants may harbour a higher risk for bacteria growth.

There is no way to prevent the onset of BIA-ALCL. However, early detection saves lives. This can be done through:

• Monthly breast self-examinations
• Annual breast checkups
• Reporting any new lumps or tissue changes to your doctor immediately
• Report any changes in breast appearance or pain to doctors, including the surrounding scar tissue

Note that the typical mammogram will not detect this type of breast cancer. Additional monitoring is necessary for the symptoms of BIA-ALCL.
If you are considering the use of breast implants, talk to your doctor about the safety concerns you have and consider alternative forms of breast implants that do not have textured surfaces.