A rare type of immune system cell cancer called Anaplastic Large Cell Lymphoma (ALCL) occurs in association with breast implants. ALCL is a lymphoma and not cancer of the breast tissue. In women with breast implants, ALCL has been found adjacent to the implant itself and contained within the fibrous capsule. The condition usually presents at an average of 7-8 years following breast implant surgery with a late onset seroma (fluid collection around the implant), and is treated with capsulectomy alone, though some cases require chemotherapy. The first case was reported in 1997, yet it is important to note that breast implants have been used since 1962, with current numbers showing there are over 10 million women in the world with breast implants. As of February 1, 2017, the FDA in USA received a total of 359 medical device reports (MDRs) of BIA-ALCL, including nine deaths. Out of 231 reports that included information on the implant surface, 203 were reported to be textured implants and 28 reported to be smooth implants. 312 of the 359 reports included information on implant fill types. Of these, 186 reported implants were filled with silicone gel and 126 reported implants filled with saline. In the UK, at least 23 cases have been identified .
Though we do not know what causes BIA-ALCL, there is increasing evidence to support an infective trigger. The time frame for its development fits with a chronic bio-film infection. In addition to the implant surface acting as a passive conduit for bacteria, it is believed that patients with genetic susceptibility and with an abnormal immune response, over time may contribute to the eventual development of BIA-ALCL. The 14 point plan (www.saferbreastimplants.org/about/the-14-point-plan/) has strategies that can be incorporated into surgical practice to prevent implant contamination and may be a useful tool in reducing the risk of BIA-ALCL.
To summarise, Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) remains a rare condition that has been identified in 360 patients worldwide. All of the information to date suggests that women with breast implants have a very low but increased risk of developing ALCL compared to women who do not have breast implants. Most cases of breast implant-associated ALCL are treated by removal of the implant and the capsule surrounding the implant, however, some cases may require chemotherapy.
Though we do not know what causes BIA-ALCL, there is increasing evidence to support an infective trigger. The time frame for its development fits with a chronic bio-film infection. In addition to the implant surface acting as a passive conduit for bacteria, it is believed that patients with genetic susceptibility and with an abnormal immune response, over time may contribute to the eventual development of BIA-ALCL. The 14 point plan (www.saferbreastimplants.org/about/the-14-point-plan/) has strategies that can be incorporated into surgical practice to prevent implant contamination and may be a useful tool in reducing the risk of BIA-ALCL.
To summarise, Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) remains a rare condition that has been identified in 360 patients worldwide. All of the information to date suggests that women with breast implants have a very low but increased risk of developing ALCL compared to women who do not have breast implants. Most cases of breast implant-associated ALCL are treated by removal of the implant and the capsule surrounding the implant, however, some cases may require chemotherapy.
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