Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)
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.
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.
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 (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:
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.
Please understand Dr. Barr will do his very best to achieve a pleasing result – HOWEVER, due to the unknown effects of tissue damage caused by the implant and its removal, cosmetic results are unpredictable and cannot be guaranteed.
The answer depends on multiple factors, including the specific combination of procedures, your recovery rates, your age and health status, and your behaviors or habits. More invasive surgeries typically require recovery time ranging between 6 and 12 weeks to 6 months, and surgeries to the same area of your body will also generally require recovery time between procedures.
However, if you are in good health and the combination of procedures in question will be performed on different parts of your body and are not especially invasive, a combination of procedures could potentially be approved together on a case-by-case basis. It is imperative that the combination of procedures does not compromise your healing, and your attention to prescribed pre-operation and recovery habits also plays a significant role. Schedule a consultation for an assessment and guidance regarding the procedures you are considering.
While aging affects us all, there are steps we can take to put forth a more vibrant appearance. We seek to perform subtle adjustments to address imperfections and the wear of time while retaining your natural look. While you should notice an improvement, the glaring changes or distortions in appearance you are concerned about and may have seen from other surgeons’ work do not meet the standard of quality plastic and cosmetic surgery we perform in our office.
Dr. Frederic M. Barr is a board-certified Plastic & Cosmetic Surgeon with over 30 years of experience performing Plastic Surgery in South Florida. We enhance and refine your appearance according to your goals. Review our Gallery of Before & After Photos to see some examples of our work.
For patients with Breast Implant Illness (BII), which can include allergy, auto-immune, and thyroid hormone issues, this has been an emerging topic with significant press coverage in recent years. Although numerous medical professionals have demonstrated varying responses to these women’s concerns, we believe in addressing these women’s experiences and symptoms. In response to this phenomenon, we have also chosen not to perform new breast implant surgeries. We perform Total Capsulectomy on patients with breast implants, which involves the removal of both the saline or silicone implant and the capsule around it.
Removal of the implants and surrounding scar tissue has been shown to improve women’s health concerning these symptoms. While some women choose no further procedure following Breast Explant Surgery, some patients elect to have a Mastopexy procedure that involves reshaping the breast tissue for a pleasant cosmetic breast appearance. We welcome your specific questions regarding these procedures and their anticipated effects for your situation. See our Breast Implant Explantation (Total Capsulectomy) page for more detailed information, including before-and-after photo examples.