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BREAST IMPLANT-ASSOCIATED ANAPLASTIC LARGE CELL LYMPHOMA (BIA-ALCL)

Mersad Alimoradi 20 Sep 2021
BREAST IMPLANT-ASSOCIATED ANAPLASTIC LARGE CELL LYMPHOMA (BIA-ALCL)

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Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon kind of cancer associated with textured breast implants.

BIA-ALCL develops from the immune cells around the implants, and less than ten women are diagnosed annually with this condition.

Breast implant-associated lymphoma develops slowly and can be successfully treated by removing the breast implant and the scar tissue encasing it.

Keep reading to learn more about BIA-ALCL, symptoms, diagnosis, and treatment options!

What is Breast Implant-associated Anaplastic Large Cell Lymphoma?

BIA-ACLCL is an extremely rare type of cancer that develops from immune cells. It rises from immune cells called "T-cells" or "T-lymphocytes", which play a very crucial role in the body's immune system.

Breast Implant-associated Anaplastic Large Cell Lymphoma is not technically breast cancer. It is classified as a " T-cell Lymphoma" or a "non-Hodgkin lymphoma", which is a type of cancer that arises from immune cells and not breast tissue.

The malignancy grows slowly and is treated by removing the implant and the fibrous scar tissue that formed around the implant (fibrous capsule). In some uncommon instances, the cancer cells can spread to surrounding lymph nodes and spread via this network to the rest of the body; it can become incurable.

Breast implant lymphoma is somewhat a recent discovery. The first case report was published in a medical journal in 1997. The FDA only reported an association between breast implants and BIA-ALCL in 2011. After that, plastic surgeons became more aware of the condition.

Most BIA-ALCL cases are typically diagnosed about seven to ten years after breast augmentation surgery and the average age of the patient at diagnosis is mid-fifties.

How common is BIA-ALCL?

BIA-ALCL is a very rare cancer type. It occurs in a very small number of women who have had breast implants, particularly textured surface breast implants.

The risk of getting BIA-ALCL ranges from 1 in 1,000 to 1 in 30,000 in women with textured devices.

Doctors are now becoming increasingly aware of the condition. Patients with breast implants who are experiencing persistent seroma or even a small lump near the implant now undergo BIA-ALCL workup.

Symptoms of BIA-ALCL

All women are encouraged to do routine self-examinations of their breasts. Especially if they've got implants.

Symptoms of breast implant cancer include the following:

  • breast swelling (the most common symptom)
  • breast pain
  • a lump near the breast implant
  • a change in the appearance or size of the breasts
  • breast skin redness

Remember that experiencing any of these symptoms is not always indicative of BIA-ALCL.

Risk Factors of BIA-ALCL

The type of implants seems to play the biggest role here. Patients with textured surface implants have a higher tendency to develop BIA-ALCL than those with smooth implants.

Having high-surface-area textured implants is currently the best-known risk factor for breast implant lymphoma.

The reason behind this is still not completely clear. Some authors have suggested that the large surface area and adherence capability of textured devices allow them to hold on to more bacteria. These bacteria are seen as the cause of the inflammation that leads to BIA-ALCL.

Moreover, many authors suspect that certain genetic factors play a role in BIA-ALCL patients.

Diagnosis of BIA-ALCL

A BIA-ALCL diagnosis is usually delayed because healthcare practitioners do not often suspect it when examining a patient with complications from a textured implant.

Plastic surgeons usually diagnose the condition when performing surgery for persistently occurring pockets of fluid (seroma) that commonly develop around a breast implant.

If you have breast implants and you're experiencing concerning symptoms, then your breast surgeon might order any or all of the following tests:

  1. Ultrasound or magnetic resonance imaging (MRI)- these are sophisticated imaging tests that will show any pockets of fluid, lumps, or lymph node swelling around your implants.
  2. Needle aspiration - Needle biopsy is ordered if there is fluid detected by the imaging. A very thin needle is used to remove a small volume of fluid and the sample is tested in the lab for neoplastic cells or inflammatory cells.
  3. CD 30 Testing - The fluid sample is tested for CD30. This is a tumor marker for various types of lymphoma and it is detected when T-cell lymphocytes are activated. The presence of CD30 is not a definitive diagnosis of BIA-ALCL but will warrant further in-depth diagnostic tests.

The differential diagnosis of BIA-ALCL includes breast cancer and other breast implant complications. This is why it is necessary to seek medical attention when you have concerning clinical features.

Treatment Options

Once the BIA-ALCL diagnosis is confirmed an oncologist takes over. They will assess the stage at which the malignancy has progressed and propose a treatment plan. The treatment plan will take various factors into account like the patient's age and overall health. 

Based on that, treatment of BIA-ALCL can involve:

  1. Surgical removal of the implant and the capsule surrounding the implant. If the disease has progressed further, the surrounding lymph nodes are also removed.
  2. In advanced disease, adjuvant treatments, like chemotherapy and radiation therapy, are also considered

If the disease is caught early enough and necessary treatment is initiated soon after, the prognosis is very good. Disease recurrence and fatal outcomes are very unlikely. Research has found that 93% of patients are disease-free at 3 years after treatment.

I Have Breast Implants. Should I Have Them Removed?

The FDA is not recommending removing breast implants if you don't have any symptoms. You should check your breasts regularly and see your doctor if you see any changes to your breast. Remember that this disease is very rare and not everyone with breast implants will develop BIA-ALCL.

FAQs

  • I'm thinking of getting breast augmentation surgery. What should I consider? Breast implants have a specific shelf-life. The longer you have them the higher the chance of removal or replacement. Over time they may deflate or rupture. They may even cause scarring, pain, or infection. You should talk with your doctor about the risks and benefits, your long-term plans regarding removal or replacement, and how to monitor any changes that may occur after the surgery.
  • How can I safeguard myself from BIA-ALCL? Ensure you have regular doctor's visits to detect any changes to the breast implant or surrounding areas. Women with breast implants should also continue to do their own monthly self-exams. It's important to note that the longer you have the implants the greater the chance of complications.
  • Are silicone implants safer than saline ones? At this time there is not enough evidence to point to either one as superior. Talk to your doctor about which implant is best for you and your goals.
  • I've decided to remove my implants. What can I expect? Once the implants are removed, your natural breast tissue may appear wrinkled or puckered. Your chest wall may also appear concave and you may experience some loss of breast parenchyma.

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About the Author:
Mersad is a medical doctor, author, and editor based in Germany. He's managed to publish several research papers early in his career. He is passionate about spreading medical knowledge. Thus, he spends a big portion of his time writing educational articles for everyone to learn.

References:

  • https://www.uptodate.com/contents/breast-implant-associated-anaplastic-large-cell-lymphoma
  • https://my.clevelandclinic.org/health/diseases/21078-breast-implant-associated-anaplastic-large-cell-lymphoma
  • https://www.sciencedirect.com/science/article/pii/S2152265020306728
  • https://pubmed.ncbi.nlm.nih.gov/29049466/
  • https://www.fda.gov/medical-devices/breast-implants/questions-and-answers-about-breast-implant-associated-anaplastic-large-cell-lymphoma-bia-alcl
  • https://www.fda.gov/medical-devices/breast-implants/things-consider-getting-breast-implants
  • https://www.aafp.org/afp/2020/0101/p8.html
  • https://www.breastcancer.org/treatment/surgery/reconstruction/types/implants/special-report/anaplastic-large-cell-lymphoma
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