BIA-ALCL, or Breast implants and Anaplastic Large Cell Lymphoma, has appeared in a number of news articles in recent months leading to concerns both from those with existing breast implants and others who might be considering this form of cosmetic surgery.
However, separating fact from speculation can be difficult when simply reading tabloid headlines. In this post, we instead look to answer some common questions including what BIA-ALCL is, how to check whether you are affected and what the risks are for anyone considering cosmetic surgery.
What is BIA-ALCL?
BIA-ALCL stands for Breast Implant Associated Anaplastic Large Cell Lymphoma. It is a rare form of lymphoma that can affect women with breast implants, it is not a form of breast cancer in itself, instead forming on the capsule that surrounds a breast implant.
When it does form – and we should stress it is thought to be extremely rare, with details of incidence rate included below – it initially stays confined to the capsule. If caught at this stage, treatment is usually removal of the implant and capsule, with no wider damage to adjoining cells, no cancer having developed on the breast. However, if left untreated a danger exists that the lymphoma spreads to surrounding breast tissue.
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What Are The Symptoms of BIA-ALCL
As with so many conditions, early diagnosis can be hugely beneficial and so it is important that anyone with breast implants is aware of the signs to check for.
The earliest sign is usually swelling of the breast, a swelling that is likely to grow larger but often without pain. The swelling is caused by fluid accumulation around the implant. If from regular checks it became apparent that the breast was swollen and there was increase in size – and this increase could be uniform or only impact one side of the breast – then a check-up should be a priority.
The likelihood might be that the swelling is unrelated to BIA-ALCL, many factors can cause swelling and BIA-ACL does not have a high incidence rate. However, the fact that it is so much easier to treat when caught early means any concerns should be investigated. There is no set time-frame in which symptoms are likely to become apparent, the swelling could occur within a year of surgery, equally it could be 20 years or further into the future.
How Common is BIA-ALCL
Any incidence rate is naturally a cause for concern for women with implants, however in the UK as of January 2020 there had only been 64 cases reported in the UK, this according to Medicines and Healthcare products Regulatory Agency (MHRA) data. In the UK there have been three deaths, with one of these meeting the World Health Organistation’s diagnostic criteria for BIA-ALCL. As of 2018 there had been 414 cases globally and 16 deaths.
The incidence rate cannot be given with certainty but it is believed to be in the region of between 1 in 20,000 and 1 in 60,000, the MHRA has suggested an incidence rate of 1 in 24,000 but the relatively small number of cases means it is impossible to give a definitive answer. It is thought that the incidence rate is higher for textured implants than smooth implants, but, while a sub division is likely within that statement, i.e. certain types of textured implants are more problematic than others, there is not yet the certainty of data to establish such associations.
For context in relation to the 64 cases in the UK to date, the breast cancer rate in the UK is that one in seven women will have breast cancer at some time in their life. There are an average of 55,000 new cases each year.
What are the causes of BIA-ALCL
Unfortunately, the precise causes of BIA-ALCL are unknown although there is extensive research into this area. It is suspected that there is a link between the condition and the coating around some textured implants and that the coarser the texture, the stronger the association.
Globally, though, there have been relatively few cases, certainly not the large number typically required before definitive conclusions can be drawn. The textured nature of the implants could be a key factor, or it could be more closely linked to how such implants are manufactured. The suggestion that textured implants are more prone to lead to BIA-ALCL than smooth alternatives can lead to a natural questioning as to why textured implants are so regularly used. The answer is that textured implants have other advantages, this often including the shaping of the implant.
It is a truism that any surgery carries risk and so it is for the patient, armed with all available information, to weigh up the advantages between smooth and textured implants. For those considering cosmetic surgery, the consultation with a surgeon is always of huge importance. It is the opportunity to talk through desired results and concerns and the surgeon to detail and advise on available options.
If I Have Any Concerns About BIA-ALCL, What Should I Do?
With any medical condition, self-diagnosis is to be avoided. The symptoms for BIA-ALCL are things that could apply to many conditions, breast swelling could be related to the condition, but is unlikely to be given there have been just 64 cases in the UK to date.
If you are concerned about your implants, the first course of action is to contact the surgeon who operated or another British Association of Aesthetic Plastic Surgeons (BAAPS) approved surgeon. If the surgeon who performed your operation is no longer contactable or working then a GP can refer you to another surgeon able to investigate. The swelling would continue but there are not obvious secondary symptoms to check for, if you have swelling or discomfort arrange a check-up.
Are Women Having Their Implants Removed?
Bar the small number of cases where corrective procedures are required, there is no call for surgery. There are certainly no calls for pre-emptive removal of implants or for a halt to new procedures for women seeking breast implants. Again, it is worth putting the figured into perspective – many hundreds of thousands of women have breast implants inserted every year, with 300,000 women per year having this surgery in the United States alone.
Women should check their breasts regularly for any lumps or concerns given the high incidence rate of breast cancer that exists irrespective of implants, in doing so they should be vigilant to the swelling that could be a sign of BIA-ALCL.
How is BIA-ALCL Treated?
The implant, capsule and any impacted surrounding tissue are removed together. If caught promptly, if the impact is limited to within the capsule, then the removal is usually adequate. If the disease has spread to beyond the capsule then chemotherapy can be required.
I Am Considering Implants, But Have Concerns
As any surgeon will state, no cosmetic surgery is without risk, however the risks can be low – in this case around one in 24,000. If you are considering cosmetic surgery, please book a detailed consultation with a surgeon and then, armed with all information, come to an informed decision.
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Ms Anca Breahna, PhD, MSc, FEBOPRAS, FRCS (Plast) is a highly regarded Consultant Plastic Surgeon specialising in the field of Aesthetic and Reconstructive Plastic Surgery. Anca performs a range of 
