Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL)

Breast Clinic

Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL) is a rare type of lymphoma that is found to be associated with breast implant (silicone or saline). It is a rare subtype of T-cell Non-Hodgkin Lymphoma (NHL), one of four sub-types of ALCL found in a small number of cases world-wide.

Causes of BIA-ALCL

When breast implants are placed in the body, they are inserted behind the breast tissue or under the chest muscle. Over time, a fibrous scar called a capsule develops around the implant, separating it from the rest of the breast.

ALCL is generally found next to the implant itself and contained within the fibrous capsule, hence it is thought to be associated with this coating around the implant.

It has been observed that most of the cases have occurred with women who have a textured implant as compared to a smoother one. This does not mean that those with a smoother implant are not susceptible to it.

According to the British Association of Aesthetic Plastic Surgeons (BAAPS), there is no recommendation that patients with textured implants should have them removed as a precautionary measure. If you are worried about the implant you have you are advised to visit your Consultant and discuss any concerns.

Symptoms of BIA-ALCL

If you notice any of the below signs or symptoms, you should get that investigated for BIA-ALCL:

  • Swelling
  • Pain
  • Increase in size in the breast over days or weeks

The most common symptom for BIA-ALCL is a breast lump or swelling caused by a unilateral seroma (collection of fluid) occurring between the implant surface and the capsule. Occasionally this can occur in both breasts.

Treatment Options

The National Comprehensive Cancer Network (NCCN) suggests that if BIA-ALCL is suspected, breast imaging is requested. If the imaging results show fluids (more than minimal) or a mass around the implant, ultrasound guided aspiration of a seroma of adequate volume is essential to test for this disease.  This is then sent for cytological (microscopic) examination to be able to make the diagnosis of BIA-ALCL and to exclude other causes.

If the tests come back positive for BIA-ALCL, the Breast Consultant advices breast implant removal. Your Breast Consultant will go through surgical treatment options best suited for you.

Total Capsulectomy

Total Capsulectomy involves first creating an insertion in the capsule and removing the implant. This is then followed by surgically removing all the scar tissue (capsule) which would include any lining that is fused along the ribs and lungs. 

En-Bloc Capsulectomy

En-Bloc Capsulectomy is a French term for ‘as a whole’. Through this surgery your breast surgeon removes the implant along with the scar tissue capsule (naturally formed as the body’s immune response to a foreign object) as a whole. The goal of this procedure is to take out the unit as a whole to protect against any silicone spillage.

In the majority of BIA-ALCL cases, surgery alone is sufficient with no additional treatment required. Although, if the disease spreads over to the lymph nodes or adjacent tissues, the patient may then need radiation therapy, chemotherapy, and/or stem cell transplant therapy to manage it. This is a very rare occurrence.

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