Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)
Breast Implant Illness (BII) is not the only health risk of breast implants. Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare form of T-cell lymphoma that develops in the scar tissue and the fluid surrounding an implant.
BIA-ALCL is not breast cancer, and it appears only to develop in women who have or had implants with a textured surface. In some cases, patients who developed BIA-ALCL have smooth-surface implants, but they had textured-surface tissue expanders before the insertion of smooth-walled implants.
Causes of BIA-ALCL
It is not clear why some women with textured breast implants get BIA-ACLC. One theory is that the rough surface of textured implants causes chronic inflammation and, ultimately, lymphoma. The larger surface of textured implants may also be more susceptible to the accumulation of bacteria, or biofilm, which can cause inflammation.
Genetic factors, such as mutations in the JAK1 and STAT3 genes, can also increase an individual’s risk of developing BIA-ALCL.
In most cases, BIA-ALCL presents as a delayed seroma 8 – 10 years after the implant procedure. A delayed seroma is the collection of a non-resolving fluid around the breast implants. Other possible symptoms of BIA-ALCL include continuous swelling, disease of the lymph nodes, skin rash, and fever.
In some cases, the presenting finding is late capsular contracture, which is the immune system’s response to foreign materials in the body.
Diagnosis of BIA-ALCL
According to the National Comprehensive Cancer Network (NCCN) guidelines, a doctor who suspects BIA-ALCL should order imaging to determine if there is fluid collecting around the implant. The collection of the fluid using fine-needle aspiration is necessary if the imaging results show a mass near the implant or fluid collection around the implant.
This sample should undergo testing for CD30, a specific protein marker indicating lymphoma. If the fluid tests positive for CD30, it should also be tested for anaplastic lymphoma kinase (ALK). Depending on these test results, an evaluation of the mass by tissue biopsy may also be necessary.
While the majority of BIA-ALCL cases present as a late seroma, a lack of a seroma does not rule out the disease. We encountered several patients in whom the presenting finding was a late capsular contracture. However, in these cases, there was no evidence of a seroma.
Doctors should inform patients who present with late-onset capsular contracture of the possibility of a BIA-ALCL diagnosis and get PET scans preoperatively.
BIA-ALCL is not only a rare condition, but it is also a newly defined condition. The first case report of BIA-ALCL appeared in a medical journal in 1997. As a result, very few plastic surgeons have experience in the treatment of BIA-ALCL. However, the NCCN provides guidelines on the diagnosis and treatment of BIA-ALCL that doctors can follow.
If a patient’s pathology results indicate BIA-ALCL, the NCCN recommends that the patient undergo surgery to remove both implants as well as the surrounding scar tissue capsules, even if BIA-ALCL only affected one implant. Surgery should also include the removal of any suspicious lymph nodes or tumors.
With timely BIA-ALCL treatment, prognoses are generally good. According to research, 93% of the patients recover fully from this illness after following treatment for three years.
Breast Implant Illness
Breast implant illness (BII) is a term that refers to the symptoms that some women may experience after undergoing cosmetic augmentation or reconstruction surgery with breast implants. These symptoms can take as little as a few days or as long as several years to develop.
Any breast implants, including textured surface, smooth surface, saline-filled, gel-filled breast implants, and silicone breast implants, can result in breast implant illness or other health concerns.
BII affects individuals’ health in different ways. Common symptoms include:
- Gastrointestinal issues
- Sleep disorders, chronic fatigue, and concentration difficulties
- Anxiety and depression
- Muscle and joint pain
- Skin problems
- Dry eyes and mouth
- Hair loss
BII is not an official medical diagnosis, and these symptoms don’t fit into the diagnosis of any other disease.
There appears to be an association between breast implant illness symptoms and the connective tissue or autoimmune diseases such as scleroderma, rheumatoid arthritis, and lupus. Some studies suggest that silicone breast implants for breast augmentation and restoration may increase an individual’s risk of developing autoimmune symptoms and autoimmune disorders. However, at this time, the evidence is not strong enough to show a direct relationship between silicone implants and autoimmune disease.
Currently, there are no diagnostic tests or criteria for breast implant illness. However, health authorities such as the U.S. Food and Drug Administration (FDA) are in the process of characterizing BII as a health condition, and health research on BII complications of silicone gel-filled breast implants and other types is on-going.
There are several approaches to treating breast implant illnesses. In many women, getting breast surgery to remove the implantation breast as well as the surrounding capsules will alleviate the implant symptoms and improve the patient’s health. In this treatment, the patient undergoes a bloc capsulectomy, which is the removal of the implant and the capsule in one piece.