Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) Dallas
Background:
- Each year 1.5 million breast implants are placed worldwide
- Over 10 million women worldwide with breast implants
- BIA-ALCL is a rare cancer arising from fluid or a capsule around a breast implant. It is a T-cell lymphoma
- The FDA is currently reviewing the data of textured implants and BIA-ALCL
- Breast Implant Associated Anaplastic Large Cell Lymphoma is much more common in a textured implant
- Europe has recently banned the sale of many textured implants because of this concern. The FDA has recently recalled all Allergan textured implants
How common is BIA-ALCL?
- 1 in 500,000 women with breast implants
- 1 in 30,000 women with textured breast implants
- 573 total cases of BIA-ALCL described worldwide and 33 deaths (possibly under reported)
What is a textured implant?
- Has an irregular surface to the silicone shell
- Purpose was to decrease capsular contracture
- Most anatomic or “tear drop” implants are textured implants
- Allergan uses a Biocell or “salt loss” technique
- Mentor uses a Siltex or “negative imprinting” technique
- Sientra uses a hybrid technique
What causes BIA-ALCL?
Many theories:
- Chronic bacteria around an implant in women who might be genetically pre-disposed
- An immune response to chronic inflammation around an implant
How to diagnose BIA-ALCL?
- A patient will present with fluid around an implant greater than 1 year after breast augmentation (the average is 8 – 10 years after)
- First step would be to get an ultrasound aspiration of the fluid and send it for CD30 immunohistochemistry
- If that is positive then the patient will be referred to an oncologist to have staging PET/CT scans (looking for capsular masses or positive lymph nodes)
Surgical treatment for BIA-ALCL?
- A total capsulectomy is recommended with removal of the breast implant
- Consider removal of the other breast implant and capsule as well
Follow up for BIA-ALCL?
- Recommend seeing your oncologist for follow up scans every 6 months for 2 years
- Depending on staging they may recommend chemotherapy although a total and complete capsulectomy is usually curative for most patients