Breast implant devices are among the most tested type of prostheses in the history of medicine. The decades of studies have shown that serious complications are extremely rare.
One concerning complication that came into the spotlight in the early 2010s is Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). This rare immune breast cancer has been the most trending topic in plastic surgery research in the past few years.
We’re still learning more about BIA-ALCL as studies emerge. We know it’s related exclusively to textured implants. We know it arises 6-12 years after the surgery. Furthermore, we know that early capsule and implant removal is 100% curative. However, many questions remain unanswered:
Keep reading to find out the latest 2022 BIA-ALCL updates, and learn more about the causes, risks, prevention, and trends in treatment.
Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a rare immune-cell cancer that develops in the breasts, and it’s been linked to textured breast implants.
This cancer arises from the immune cells in your breast (T-cell lymphoma). It usually presents as a seroma; a collection of fluid near your breast implant that can cause deformity or pain. Others might feel a tumour in the breast or armpit.
BIA-ALCL is 100% curable with surgery if you receive an early diagnosis.
The first reported BIA-ALCL case was in 1997, and since then, there have been increasing reports of this condition from all around the world. As of 2011, the plastic surgery community has acknowledged the link between BIA-ALCL and the use of textured breast implants.
After a few years, researchers noticed that 85% of the cases of breast implant lymphoma happened with Allergan’s Biocell implants (a popular brand at the time). This has lead the company to issue a worldwide voluntary product recall in 2019. Meaning, every woman with an Allergan Biocell implant can get hers removed and receive free smooth replacement implants instead.
Until today, no cases of BIA-ALCL have ever been reported with smooth-surfaced implants.
The symptoms of breast implant cancer have been known for some time, and emerging research does not seem to add anything new in this regard. So far, the most common symptoms of BIA-ALCL are:
When you notice one or more of these symptoms, you should not delay visiting your plastic surgeon. There’s a very high chance that these symptoms are caused by a more benign process, like implant rupture or capsular contracture. However, a surgeon’s evaluation is crucial to rule out breast implant cancer early on.
Unfortunately, doctors are still not exactly sure how textured breast implants cause BIA-ALCL. The strongest theory suggests that BIA-ALCL is a result of chronic inflammation around the breast implant that causes immune cells to turn malignant. Genetics might also play a role in making you more susceptible.
This is probably the most accepted theory so far. A chronic inflammation that happens around the implant might be the cause of BIA-ALCL. The inflammation causes your immune cells to mutate and become cancerous.
The fact that BIA-ALCL is more associated with textured implants fits into this theory. Textured implants have a much larger surface area, and can hence be more easily and heavily colonized with bacteria. Here’s how doctors think breast implant cancer starts:
Other theories suggest that silicone itself might contribute to inflammation (silicone auto-immunity). Some also suggest that viruses might also play a role. Nevertheless, these theories are still far from being confirmed.
Your skin and breast tissue are full of residing bacteria. If they come in contact with your implant, they might cause complications like infection, capsular contracture, breast implant illness (BII), and BIA-ALCL.
Some studies have identified no difference between bacteria in BIA-ALCL patients and non-cancer patients. This might lead to the conclusion that developing BIA-ALCL depends more on your own immune response and genetics, which determine how your body reacts with the colonizing bacteria.
In any case, bacteria are still thought to be the initiator of this inflammatory response. This is why sterility is critical in preventing BIA-ALCL. For this reason, many surgeons around the globe follow the 14-point plan for breast surgery.
The 14-point plan is a work plan that ensures maximal sterility when performing a boob job to prevent any bacterial colonization of the implant.
The plan includes steps like using nipple shields, Keller funnels, changing gloves regularly, antibiotic and betadine wound irrigation, IV antibiotic administration, and others. The aim is to make the risk of bacterial colonization negligible.
