BIA-ALCL (Anaplastic Large Cell Lymphoma) Sydney

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Symptoms: Persistent swelling in the breast due to fluid collecting around the implant is most common. Less commonly, a lump in the breast or armpit can occur.

Who is at risk?

BIA-ALCL has occurred in individuals with both silicone and saline implants for either cosmetic or reconstructive purposes. All individuals who have developed this disease have had exposure to textured or polyurethane breast implants. There appear to be genetic factors that affect the disease’s incidence. Ongoing research is examining this connection.

How is BIA-ALCL diagnosed?

If an individual develops a persistent fluid collection around their implant, they should have an ultrasound examination. If fluid is detected, this will be extracted and tested (using immunohistochemistry) for BIA-ALCL. Most fluid collections will be benign seromas and not BIA-ALCL.

Mammograms are not helpful for diagnosis. If the disease is detected and a diagnosis established, MRI and PET CT scans will be performed to help stage the disease and plan surgery.

How is BIA-ALCL treated?

Treatment involves removing the breast implants, along with the fibrous capsule surrounding them, from both breasts. However, the incidence of bilateral disease is rare. This treatment has cured individuals of the disease in the vast majority of cases. All women who have been diagnosed and treated without delay have achieved a complete remission.

Should I have my implants removed?

Medical experts do not recommend that you have your implants removed if you have no symptoms of BIA-ALCL. This is because the disease is extremely rare, and the risk of undergoing surgery could be higher than the risk of developing BIA-ALCL.

Can implants be re-inserted when BIA-ACL is being treated?

No. If an individual is being treated for BIA-ALCL, both breast implants are removed. This is because a small number of cases have been diagnosed in both breasts at the same time. Implants are not replaced during this procedure. In a small number of cases, some patients have waited before having smooth implants re-inserted and have not experienced any disease progression. However, the safety of this plan is still being investigated.

Do I need to be regularly screened for BIA-ALCL?

No, currently, it’s the opinion of medical experts that you do not need regular ultrasound scans without symptoms or changes to your breasts. However, if you notice any changes in your breasts associated with implants, or if you notice a generalised swelling or lump, you should have a breast examination to investigate the cause.

What causes BIA-ALCL?

There is a theory that bacteria cause this disease. A global collaboration of researchers is investigating the cause of this disease, which is a rapidly developing area.

I am considering breast implants. What should I do?

When considering breast implant surgery, you should discuss all risks and benefits of the procedure with your specialist plastic Surgeon. This will include discussing the risk of BIA-ALCL and should be part of the consent process.

There are risks and benefits associated with different implant types, and these need to be taken into account when choosing implants. However, implant selection will vary between individuals. Individuals must understand that breast implants are not lifetime devices. Those with implants should anticipate revision or replacement of the breast implants at some stage, due to implant rupture, capsule contracture, implant migration or size change.

Can we make breast implants safer?

In addition to a possible connection between bacteria and BIA-ALCL, infection is also linked to capsular contracture and acute infection. Infection control is vital in breast surgery to ensure the best outcomes. Plastic surgeons are specifically trained to ensure the highest standards of patient care and lower risk of infection.

Where can I get further information?

To read up-to-date information and advice on BIA-ALCL, please visit the Australian government’s TGA Website here.