What Is Breast Implant–Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)?

Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is a cancer of the immune system, called non-Hodgkin lymphoma. It's not breast cancer, which often originates in the milk ducts. BIA-ALCL is thought to be caused by textured breast implants, which house bacteria in the scar tissue that grows as the breast tissue heals after the surgical procedure.

This article discusses the symptoms, diagnosis, and treatment for this cancer.

Though it was first reported in 1997, it wasn't until 2011 when the Food and Drug Administration (FDA) had enough evidence to make the connection between lymphoma and a specific type of breast implant, the Biocell textured saline and silicone-filled implants and tissue expanders.

The Biocell model is made by the pharmaceutical company Allergan. In 2019, the FDA requested that Allergan recall the models of the breast implants causing BIA-ALCL. Allergan complied and advised the patients who had that model implanted to reach out to their plastic surgeons if they had concerns.

There is a possibility of a genetic predisposition to this type of cancer. Small studies have made the connection regarding genetic mutations, but more research is needed.

BIA-ALCL is very rare. Of the millions of women with breast implants worldwide, only 733 cases of BIA-ALCL had been reported to the FDA as of August 2020. The prognosis is good when caught early.

Types of Breast Implants

There are a variety of breast implants to choose from, including:

• Saline: Implants are filled with sterile, salt water
• Structured saline: Built with an inner structure that is made to feel natural
• Silicone: Implants filled with silicone gel
• Gummy bear: A little bit thicker and firmer than silicone implants
• Smooth: Implants that are very soft and said to provide natural movement
  
• Textured: Implants that are made so that scar tissue sticks to them, making them less likely to slip out of place

It is only the texture on the outside of the implant that causes risk for BIA-ALCL, not what the implant is filled with.

Symptoms of BIA-ALCL

After you have had breast reconstruction surgery with textured breast implants, watch for symptoms of BIA-ALCL.

These can include:

• Swelling or fluid accumulation in the breast or around an implant
• Lumps
• Pain in and around the breasts
• Changes in the shape or size of the breast or breasts
• Redness

If one of more of these symptoms occurs, you should seek a physical examination with a healthcare provider and get further testing if needed.

Diagnosis

If you experience any changes to the look or feel of your breast implants, the first step is to see a healthcare provider for a physical exam.

Following the exam, they may recommend the following tests:

• Ultrasound or magnetic resonance imaging (MRI): This will find fluid or lumps in the breast, or swelling of the lymph nodes. This is different than—and not a substitute for—a mammogram, which is used to detect breast cancer.
• Needle biopsy: If extra fluid or lumps are found, a needle biopsy is the next step. A healthcare provider will use a very thin needle to extract fluid from the breast and send it to a lab for analysis and detection of cancer cells.
• CD30 immune staining: The fluid from the needle biopsy will be tested for the presence of CD30, which is a protein found on some T cells and B cells (types of white blood cells). CD30 is a marker for lymphoma.

Treatment

If cancer is found, the person will be referred to a hematologist (a doctor who specializes in disorders of the blood) and/or an oncologist (a doctor who treats cancer) who specializes in treating lymphomas.

Treatment largely depends on the stage of the cancer, general health of the patient, and their age.

Possible treatment options include:

• Surgical removal: Removal of the breast implants and possibly some nearby lymph nodes. Removing lymph nodes can prevent the cancer from spreading, but if cancer is found in the lymph nodes, that is an indication that the cancer has spread.
• Chemotherapy: If the cancer is advanced, this treatment therapy that uses drugs to kill cancer cells may be necessary. The standard of care for this type of lymphoma is a combination of chemotherapy and steroids referred to as CHOEP, which includes cyclophosphamide, doxorubicin (hydroxydaunomycin), vincristine, etoposide, prednisolone.
  

Additional Surgical Options for Breasts

Instead of pursuing manufactured implants, there are a few other options women may consider, including:

• Flap reconstruction: A breast surgeon removes fat from other areas of the body, such as the belly, buttocks, or thighs, to create breasts.
• Fat grafting: A surgeon removes fat from other areas of the body, such as belly, buttocks, or thighs, using liposuction to create breasts.
• Going flat: If the person had a mastectomy (surgery to remove a breast or both breasts) from breast cancer and no longer wants breasts or implants, a surgeon can close up the area where the breast implants were placed and create a flat surface.

Summary

BIA-ALCL is a rare cancer of the immune system that can develop from textured breast implants following breast reconstruction surgery. It is not a form of breast cancer. If symptoms of BIA-ALCL appear following surgery, contact your healthcare provider or the surgeon who performed your breast reconstruction surgery for a diagnosis and treatment options.

A Word From Verywell

If you have any concerns about your implants, reach out to your healthcare provider, especially if you are considering having them removed or replaced. The FDA does not currently recommend that women have these breast implants removed unless they are having problems or uncomfortable symptoms, although some surgeons suggest having them removed or replaced to give women peace of mind.

If you are diagnosed with BIA-ALCL, know that there are effective treatment options available. Still, the condition can be overwhelming. Some people find comfort in joining support groups, which can help connect you with people who are also going through a similar experience.