Breast Implant Associated Cancer (BIA-ALCL) in the News Again

woman thinking about BIA-ALCL

Most of our life choices carry a certain amount of risk. Each time we get behind the wheel of the car or sign a form allowing our child to participate in sports, we accept a basic level of risk.  We do this because we feel the reward outweighs the potential downside. When choosing to have a plastic surgery procedure, we do the same thing. All surgeries carry the risk of complications, but we choose the path that makes the most sense based on our goals, lifestyle, and comfort with risk.

Most of the more common complications associated with cosmetic procedures are relatively mild and can be avoided with proper preparation before surgery and care after surgery. But occasionally a rare complication arises that has more serious repercussions. In the case of breast implants, Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is one of those rare complications.

BIA-ALCL has predominantly occurred in patients who have, or at one time had, textured breast implants. Reports of the disease developing in patients who have only had smooth implants lack adequate patient history for confirmation, but even so, the unconfirmed reports make up a tiny fraction of the cases.

This unusual cancer is a cancer of the immune system (called a lymphoma) not a cancer of breast tissue itself. It occurs in people without implants but is exceedingly rare. Why it can develop around a breast implant not clear, but it is thought to be related to how a person’s immune system reacts to the implant surface, specifically a textured-surface implant. It typically occurs within the natural scar tissue (capsule) that forms around the implant but can develop as a mass within the breast.

According to the FDA, BIA-ALCL has been reported 457 times in association with breast implants since 2010, but it appears that some of these reports are duplicates. Either way it is quite a rare complication. In fact, the risk of developing the disease for women with textured implants is somewhere from 1 in 3,817 to 1 in 30,000. For perspective, the overall risk of developing breast cancer due to all causes is one in nine. Even though the numbers are small, the association with breast implants is clear. Most cases are caught early and cured with the removal of the implant and the scar tissue surrounding it. Three-year disease survival is reported to be 93 percent. More advanced cases with cancer spread have been reported, and these cases do require chemotherapy. The nine reported deaths in the US from the disease occurred in patents who did not receive these recommended treatments.

We first updated you on BIA-ALCL in 2017, when the FDA announced the association between breast implants and the cancer had been identified. More recently, the FDA has addressed primary care physicians about the issue. As most women don’t see a plastic surgeon for routine health care, it is more likely to be a primary care physician (PCP) who will detect a lump or other change in the breast. This means PCPs must be aware of the special attention a woman with breast implants requires when providing her ongoing care.

As a patient, it pays to be proactive as you think about potential complications of breast implants. Below you will find concrete actions you can take that will give peace of mind about choosing a procedure and living with the results for years to come.

  1. Prior to surgery, discuss all possible complications with your plastic surgeon, including the possibility of BIA-ALCL. Compare the risks and benefits of different types of surgeries and implants to make the decision that is right for you. If your surgeon isn’t up front about potential risks, he or she is not the right surgeon for you.
  2. Do everything your surgeon recommends to prepare for a successful surgery – quit smoking, exercise, eat a well-balanced diet, and limit your alcohol intake.
  3. After surgery, strictly follow the post-operative instructions your surgeon provides for you.
  4. Have a frank discussion with your PCP about your breast implants and ask them to brush up on the latest research on BIA-ALCL. You might even share the FDA letter with them to be sure you are on the same page. Follow-up with them as recommended so they are able to detect any changes over time.
  5. The most common symptoms of BIA-ALCL are the development of fluid (seroma) around the implant several years after surgery, lumps, swelling or pain within the breasts. If you have any concerns at all about your breast implants, always contact your surgeon. He or she is in the best position to evaluate any symptoms that are bothering you.

If you are thinking about getting breast implants or have concerns about the implants you already have, Dr. Slack is your best local resource. Not only is he a member of the American Society of Plastic Surgeons, he completed a fellowship in breast surgery at Georgetown University Hospital in Washington D.C. He would like to discuss your questions with you and help provide a clear view of the risks and benefits of any procedure you choose. Contact our Collin County office to schedule a consultation.

Breast Implant-Associated Lymphoma: Know the Facts

Update: The American Society of Plastic Surgeons provided an update on BIA-ALCL in January of 2018. Please follow this link to read more.

If you haven’t already heard, you should know that there is a rare cancer associated with breast implants (both saline and silicone gel). It’s called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). It occurs mostly with implants that have a textured surface, though there have been cases with smooth-surfaced implants. As of March 21, 2017 there have been 126 confirmed cases of BIA-ALCL reported in the United States.

A possible association between this cancer and breast implants was identified by the U.S. Food and Drug Administration (FDA) in 2011, but there wasn’t enough solid evidence to confirm a connection or make any recommendations at that time. The following year, the Plastic Surgery Foundation collaborated with the FDA to create a patient registry called PROFILE (Patient Registry and Outcomes for Breast Implants and Anaplastic Large Cell Lymphoma, Etiology and Epidemiology).

PROFILE was created to better understand the relationship between breast implants and ALCL, to find risk factors, “diagnostic predictors, and the best ways to manage this disease.” During that time, researchers also began to double down on their efforts to understand this disease and any association with breast implants.

In 2016 the World Health Organization officially recognized a link between breast implants and ALCL, and the FDA agreed:

“All of the information to date suggests that women with breast implants have a very low but increased risk of developing ALCL compared to women who do not have breast implants.”

By this time, the research had also revealed that the cancer was most often associated with implants that had a textured surface. ALCL is not a cancer of the breast tissue itself, but occurs in the capsule that forms around the implant. It usually develops between two and 28 years after a patient gets implants and occurs with the onset of symptoms like swelling of the breast or lumps in the breast or armpit.

Fortunately, BIA-ALCL is not only rare but also has a very good prognosis. The National Comprehensive Cancer Network says the best treatment is to completely remove both implants and the capsules that have formed around them. Ninety-three percent of patients who undergo treatment are disease free within three years.

In March, 2017, the FDA updated their website to include more information on BIA-ALCL, including their current recommendations and a number of patient and physician resources. Here are their most current recommendations:

Before you have surgery: Educate yourself about BIA-ALCL before having surgery, and talk to your surgeon about the risks and benefits of textured versus smooth-surfaced implants.

If you already have breast implants: If you don’t have symptoms, there is no need to change your routine medical care and follow-up. However you do need to be sure to follow the standard recommendations given by your surgeon for routine care.

If you have breast implants, it is important that you follow all of your surgeon’s instructions in the early days and months after surgery but also in the years thereafter. Your surgeon will likely want to follow up with you each year to examine and discuss your implants. It is also important that you continue with routine cancer screenings including self exams, physician exams, and mammograms as recommended by your doctor.

If you have had breast implants, keep an eye out for any changes in your breast size or symmetry, rippling or hardness around your implant, or lumps in your breast or armpit. If any of these occur or you are simply concerned about your breasts for any reason, don’t hesitate to make a follow-up appointment with your plastic surgeon.

If you want to know more about BIA-ALCL, the risks and benefits of textured versus smooth implants, or whether breast implants could be right for you, contact our office in Collin County, Texas for your consultation.