Breast implant associated lymphoma (BIA-ALCL) is an uncommon cancer of the immune system that is associated with certain forms of breast implants.  As of April 2022, the Food and Drug Administration in the USA confirmed a total of 1170 cases worldwide since the condition was first discovered.  Around 10-20 of these have occurred in New Zealand.  To put this number in context, there were 365,000 breast augmentations performed in the USA in 2021 alone (The Aesthetic Society, 2022).  Nevertheless, with any risk associated to anything used in cosmetic surgery, it is important for me to understand what we know so far so I can be best placed to pass this information onto my patients to help them make their decisions on treatment.

What we know:

BIA-ALCL seems to be most commonly associated with breast implants that have a thick texture to their surface.  This texture pattern was originally introduced with the objective of reducing tightening of the scar tissue that naturally forms around the breast implant, as well as lowering the chance of the implant slipping towards the armpit or abdomen.  Thick texturing of breast implants became popular and was widely used throughout the world.

Since the discovery of BIA-ALCL, it has become clear that, amongst those who develop the disease, the vast majority have, or have had, an implant with this thick texturing on its surface.  A recent scientific report in the Aesthetic Surgery Journal confirmed that there are no reported cases of BIA-ALCL amongst patients who have just had smooth surface breast implants.

Amongst those who do develop BIA-ALCL, the time at which the disease develop appears to be around 10 years after the breast augmentation operation.  That being said, it has been reported to occur as soon as 1 year, as a long as 42 years after the original surgery.

The most common way for BIA-ALCL to become apparent to the patient and surgeon is through the development of fluid around the implant, or a lump within the breast.  This fluid or lump should then be sampled and analysed in a laboratory to look for any evidence of BIA-ALCL.  Almost all patients, thankfully, present with the disease confined to the area around the implant and not having spread anywhere else in the body.

If caught early enough, the existing data on BIA-ALCL shows that, 3 years after treatment, 93% of patients with BIA-ALCL remain free of any further cancer.

What should we do?

As with all things in healthcare, prevention is better than cure.  Avoiding the use of breast implants that have a thick texture to their surface is a key step in keeping patients as safe as possible.  I use Motiva implants, which use a nano-textured surface and were first brought to market in 2010.  This surface has been officially designated as compatible with a smooth surface.  Currently, there are no reported cases of BIA-ALCL with Motiva breast implants.  I will continue to carefully evaluate their safety profile over the years to come.

The next question comes on what to advise patients who have an old breast implant in place that has the thick texture to their surface.  Should surgeons recommend removing and replacing these implants to help reduce the risk of that patient developing BIA-ALCL?  The answer to this at the moment is that we still don’t know.  Firstly, it should be remembered that the risk of developing BIA-ALCL amongst those who have the high-risk implants in their breasts is in the region of 1 in 3000 patients. A recent study from a well-respected plastic surgeon with a wealth of experience in this area, did find that in replacing breast implants did cause around a 30% drop in the risk of patients developing BIA-ALCL (Di Pompeo, Aesthetic Surgery Journal 2023).  Although this may sound like a sizeable reduction in risk, it would actually only drop the real risk of developing BIA-ALCL if a patient had high risk breast implants in place from a 0.03% to a 0.02% risk. It should also be remembered that the benefit gained needs to be carefully balanced against the risk of a further general anaesthetic operation to chance the implants, although a further medical study in 2022 found a 0% risk of death amongst 100,000 patients undergoing breast augmentation.  My approach remains that I have a careful discussion with my patients in this situation, talking through the risks and benefits of each approach and then coming up with a plan that works for them.

Amongst those who do develop BIA-ALCL, the knowledge on what is the best treatment for patients continues to improve, and it appears we have good treatment options available that give very good survival rates.

If you’re thinking about a breast augmentation, or you are unsure what to do with your old breast implants, I hope this blog provides a useful overview of this important, but thankfully rare, complication.