Breast implants do not cause or increase the risk of breast cancer, but they have been linked with Anaplastic Large-Cell Lymphoma (ALCL), a rare cancer of the immune system. According to the Food and Drug Administration (FDA), the use of breast implants with textured surfaces and polyurethane outer shells has a very low but increased risk of ALCL. The cancer is also called Breast Implant-Associated Anaplastic Large-Cell Lymphoma (BIA-ALCL) because of its link with certain breast implants.

What is BIA-ALCL?

Breast Implant-Associated Lymphoma is not breast cancer. It is a type of non-Hodgkin’s lymphoma, a cancer of the immune system. Most cases of the cancer occur around the scar tissue and fluid near the breast implant. However, in some cases, it can spread throughout the body. Though the risk of developing BIA-ALCL is very low, the cancer is serious and can lead to death, particularly if not treated early.

How is BIA-ALCL associated with breast implants?

While the link between breast implants and Anaplastic Large-Cell Lymphoma is still unclear, it is believed that the growth of bacteria on the surfaces of breast implants can, eventually, result in increased stimulation of lymphocytes. The stimulated lymphocytes may then trigger an immune response that leads to BIA-ALCL. Since only 1 in 50,000 women with breast implants develop the disease, the chance of BIA-ALCL being triggered by implants is considered very low. Also, the risk does not increase with either silicone or saline-filled implants. Because the immune response that causes BIA-ALCL depends on the growth and proliferation of bacteria, the risk of cancer is related to the surface area of the implant. Textured implants and expanders have a higher surface area compared to smooth implants, resulting in a higher risk of BIA-ALCL compared to smooth surface implants. In fact, up to 96% of cases of the cancer are reported in patients with breast implants with textured (bumpy) surfaces and polyurethane outer shells.

What are the warning signs?

When BIA-ALCL occurs, it tends to arise more than one year after breast augmentation surgery. Patients develop chronic swelling, a mass (lump), pain, or fluid buildup around the implant. The breast may harden, have new scar tissue, or may be painful around the vicinity of the implant. Plus, there may be hair loss, skin rash near the breast, and exhaustion (a sign of a weakened immune system).

Is BIA-ALCL curable?

ALCL is curable, particularly when discovered early. To diagnose ALCL, the doctor will perform a needle biopsy and an imaging test (mammogram or ultrasound). Early treatment typically involves the removal of the implant and the surrounding scar tissue. But, in some cases, chemotherapy and radiotherapy may be necessary.

What should you do?

If you are considering breast augmentation, reconstruction, or replacement (revision) with breast implants, you should discuss your goals and expectations with your plastic surgeon. Your surgeon will also explain the benefits and risks of having breast implants, the need to monitor implants for complications, and their eventual replacement or removal. If you already have breast implants, concerns related to BIA-ALCL should not mean you remove them. If there are no symptoms, no need to worry. Instead, you should speak with your plastic surgeon about the risk of developing the cancer. But if you do have symptoms, talk to your doctor about further evaluation, confirmation, and treatment of the cancer. At Politis Plastic Surgery, we do not use breast implants and tissue expanders that the FDA has listed as a potential cause of BIA-ALCL. During the consultation, we inform our patients about the risks associated with breast implants, including BIA-ALCL. When treating patients with suspected BIA-ALCL, we develop individualized treatment plans in coordination with experts in the diagnosis and treatment of the cancer. Do you have questions or concerns about the use of breast implants in breast augmentation or reconstruction? Dr. Effie Politis will answer your specific questions and help you make an informed decision about cosmetic surgery. For more information on breast implants and associated risks and complications, visit the Politis Plastic Surgery website.

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