Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is rare.
It is not a breast cancer. It is a highly treatable, non-aggressive cancer of the immune system that can develop in the fluid and scar tissue around breast implants.
Breast implant associated cancer is very uncommon. Because the numbers are so low it is hard to be exact, but it probably occurs in something like one in 10,000 textured implants. Only 80 cases in total have been reported in Australia and around 700 cases world-wide since 2009, out of about 30 million women with implants world wide. In Australia alone, over 15,000 breast implants procedures are performed each year.
Breast implant associated lymphoma causes a swelling* of one breast due to fluid build-up around the implant. It may also appear as a lump in the breast or armpit, breast enlargement or new breast asymmetry. Pain may be associated but is not the main symptom.
*This does not include swelling in the first 6 months after your implants are put in, which is usually due to post surgery swelling.
If you develop new breast swelling more than 6 months after your implant was put in, an ultrasound will show if the swelling is due to a build-up of fluid. If there is a significant fluid build-up (called a seroma), a sample of fluid will be removed under ultrasound guidance, and sent to the laboratory for analysis. Most fluid build-ups are caused by post surgical change, or infection, not lymphoma, but we will test for a number of conditions, including lymphoma.
It is important to realise that there are more common causes of lumps and of pain associated with a breast implant. The most common implant abnormalities we find are capsular contraction (shrinking of the scar around the implant) and silicone leakage, both of which can cause a lump and pain.
We do not routinely use pathology tests to screen women without symptoms, due to the risk of infection.
If you are healthy and have no breast symptoms you are very unlikely to have breast implant associated lymphoma.
You do not need to have your implants removed ‘just in case’. Your implants only need to be removed if you have symptoms which are proven to be due to breast implant associated lymphoma (BIA-ALCL) on seroma fluid testing.
If you develop swelling in a breast with a breast implant, ultrasound is the best test.
At Sydney Breast Clinic we always perform ultrasound of breast implants as part of our usual breast evaluation. This is because we know that mammography cannot visualise all of the breast tissue when implants are present as the implants ‘get in the way’ of the mammogram. We are mainly checking for cancers in the breast tissue, but we also check the implant surface for leaks and other abnormalities, such as fluid build-up. This has been our routine for over 15 years. If any implant abnormality is found, further investigation may be required.
The cause of breast implant associated lymphoma is not silicone. It seems to be an immune reaction to the surface of the implant. Breast implant associated anaplastic large cell lymphoma is seen with textured implants (not smooth implants) and in particular some types of macro-textured implants. Texturing is used to stop breast implants slipping out of place and to help prevent hardening of breast implants.
If you do not remember whether your implants are smooth or textured, your original surgeon will be able to advise you on these details. If the surgeon or clinic which performed your original implant operation is no longer available, your GP can advise you and refer you to another surgeon. If your surgeon recommends removing your implants despite not having any symptoms, we recommend you seek a second opinion.
The treatment of breast implant associated lymphoma is removal of the implant along with its capsule (which is the scar tissue that your body forms around the implant). Usually that is the only treatment necessary. Your own breast tissue does not usually need to be removed beyond the implant capsule.