Breast Implants and Cancer: The Truth About ALCL

Published on October 9, 2018 by
Breast Cancer Patient

Not only is breast augmentation the most performed surgical procedure at Ciaravino Total Beauty, but it is also one of the most popular aesthetic plastic surgeries worldwide. Over 300,000 women receive breast implants each year, according to the American Society of Plastic Surgeons, and it has been the number one cosmetic surgical procedure every year since 2006. Breast augmentation is safe, offers many options for personalization and has an extremely high rate of patient satisfaction.

While complications do not occur in most cases, any surgery carries some degree of risk. Potential side effects of breast augmentation include infection, hematoma, displacement or deflation of the implant, leaks or ruptures, and capsular contracture (tightening of the scar tissue around the implant). Severe medical complications are unlikely to arise. However, over the last decade, some breast implants have been linked to cancer of the immune system called anaplastic large cell lymphoma (ALCL).

Patient safety is a priority at Ciaravino Total Beauty. Dr. Ciaravino performs more breast surgeries than any other surgeon in the Houston area, and post-operative problems are rare in his practice. Though ALCL related to breast implants is uncommon and treatable, it’s important for patients to become educated about the risks and benefits associated with breast augmentation, so they can feel absolutely comfortable in their decision to go ahead with. surgery.

What Is ALCL?

Anaplastic large cell lymphoma (ALCL) is a rare type of fast-growing non-Hodgkin lymphoma (NHL), a cancer of the cells of the immune system. ALCL occurs when white blood cells known as T-cells become abnormal. These abnormal cells typically build up in the lymph nodes but can affect other areas of the body in some cases.

In 2011, the FDA identified a possible association between breast implants and the development of a singular type of ALCL: breast implant-associated anaplastic large cell lymphoma (BIA-ALCL).

BIA-ALCL is a form of lymphoma that develops near breast implants. It usually presents as a pocket of clear fluid, called a seroma, that develops between the implant and the surrounding fibrous scar capsule. In most cases, the affected cells are confined to the seroma fluid and do not invade the capsule, allowing for conservative surgical treatment rather than chemotherapy. Though this lymphoma specifically affects the area around the breast implant, it is not breast cancer.

BIA-ALCL can develop regardless of whether the implant was inserted for cosmetic reasons or breast reconstruction following a mastectomy. The type of filler material also does not appear to be a risk factor; BIA-ACL can occur with both saline and silicone implants, of any shape or size. However, research to date does suggest that the risk of developing BIA-ALCL increases when using implants with a textured surface. It has not been found in implants with a smooth outer shell.

BIA-ALCL is rare and curable. As of 2018, the FDA reported only 414 cases worldwide, and studies suggest that between one in 1,000 to one in 30,000 breast implant patients are affected.

Signs and Symptoms of BIA-ALCL

The primary symptoms of BIA-ALCL are persistent swelling or pain in the vicinity of the implant. Capsular contracture or a lump under the skin of the breast or armpit may also be present. Evidence of fluid accumulation is frequently observed during evaluation by a health care provider. These symptoms can occur long after the augmentation procedure was performed and the incision has healed, often years after implant placement.

Having one or more of these symptoms does not guarantee a BIA-ALCL diagnosis. Nevertheless, it is essential to discuss any discomfort or unusual symptoms with your doctor to determine whether they indicate a serious health problem.

Diagnosing BIA-ALCL

In the event you experience breast swelling or pain that could be associated with BIA-ALCL, an ultrasound scan will be performed to determine whether fluid collection is the cause. If fluid is indeed present, it will be removed and analyzed. Most fluid collections are not ALCL, but testing is essential to be sure. Further investigations such as MRI and CT scans are typically performed if analysis of the fluid confirms an ALCL diagnosis.

Treating BIA-ALCL

BIA-ALCL tends to remain confined to the seroma fluid without invasion of the capsule around the implant. For this reason, surgical intervention to remove the implant and capsule is an effective method of treating BIA-ALCL in a majority of cases. Most patients have a good prognosis for recovery with timely diagnosis and complete surgical excision of the lymphoma, implant and surrounding fibrous capsule.

In cases in which removal of the implant and capsule does not cure BIA-ALCL, a solid lump is found in the breast, or lymph node involvement has occurred, chemotherapy or radiotherapy may be required. Most diagnosed cases are adequately treated with surgery alone.

Questions and Concerns

If you are considering breast implant surgery, or have already undergone the procedure, you may have questions about your risk of developing BIA-ALC:

Should women with breast implants be screened for BIA-ALCL?

If you have not experienced symptoms or changes in the breast associated with BIA-ALCL, there is no need for examination beyond routine check-ups. An ultrasound is required only if relevant changes occur, particularly if there is swelling or a lump.

Should my implants be removed, just in case?

Breast implants are not lifelong devices. Most will need to be removed or replaced at some point, but there is no current recommendation for preventative removal for women with no symptoms of BIA-ALCL.

Are some women more at risk than others?

More research is required to make final recommendations about risk factors for BIA-ALCL. Based on currently available data, the fill material (saline or silicone) and the type of surgery (cosmetic augmentation or breast reconstruction) do not appear to be factors. Evidence suggests that women with textured implants may be more likely to develop BIA-ALCL than women with smooth implants.

How can I reduce my risk?

Choosing a skilled and knowledgeable physician is the best way to mitigate the risk of developing BIA-ALCL or any other surgical complication. Dr. Ciaravino performs around 800 breast surgeries each year. He has developed an array of techniques designed to reduce your risk for possible complications, and will thoroughly review all breast augmentation options, risks and benefits during your consultation. To learn more, contact Ciaravino Total Beauty today at 713-627-1200.