Important information for patients with textured breast implants

Recent studies have identified an association between textured implants and a rare form of cancer called Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). As of May 28, 2019, Health Canada has officially banned the sale and import of these specific implants. Although the incidence of BIA-ALCL is extremely low, it essential that patients who have textured implants are informed and educated about this condition.

What is BIA-ALCL?

Breast Implant-Associated Anaplastic Large Cell Lymphoma is a rare T-cell that can arise around breast implants. BIA-ALCL is not a cancer of the breast tissue itself, but a cancer that affects the immune system. It develops around the scar tissue from the implant and in certain cases can spread throughout the body.

Is BIA-ALCL common?

According to Health Canada, do date there have been fewer than 30 confirmed cases of BIA-ALCL in Canada. The FDA reported the risk of developing this disease is 1:3 817 to 1:30 000. This is the most accurate current information; however, these risk estimations are changing on an ongoing basis. These estimates refer to patients with textured breast implants. No cases of BIA-ALCL have been reported in Canada with any smooth surface implants.

What are the symptoms of BIA-ALCL?

BIA-ALCL is most commonly reported at an average of 8-10 years after implantation. The first symptom is usually swelling of the breast, due to a build-up of fluid around the implant. Other symptoms include pain, lumps in the breast or armpit, firmness of the breast and unevenness between breasts.

How is BIA-ALCL diagnosed?

There is no blood test to specifically screen for BIA-ALCL. If swelling develops, it is recommended to undergo an ultrasound scan. If fluid is detected, it should be drained and tested. In the case of a diagnosis, the treatment consists of implant removal and total capsulectomy. Mammograms are not useful in diagnosing BIA-ALCL.

Is BIA-ALCL treatable?

BIA-ALCL is usually easily and completely treated if patients see their doctor at the first symptom. In most cases, it can be treated by removing the breast implant and surrounding scar capsule, however, additional treatment may be necessary depending on the patient. The majority of patients require no additional treatment.

Have there been any deaths due to BIA-ALCL?

In cases where the disease has spread throughout the body, rare cases of death have been reported. Globally, there have been 21 confirmed deaths attributed to BIA-ALCL since the disease was first reported nearly 20 years ago.

What should patients with textured implants do?

Concerning textured implants, neither the FDA, Health Canada, nor any plastic surgery society currently recommends that women have their implants removed to prevent BIA-ALCL, if no signs and symptoms of the disease are present. As every surgery has its risks, patients should discuss the risk and benefits of textured breast implant removal with their healthcare professional and plastic surgeon. Health Canada encourages breast implant patients to conduct regular breast self-exams and see their healthcare professionals for periodic follow ups.

What types of implants are associated with BIA-ALCL?

Of the cases of BIA-ALCL, it has been associated with both saline and silicone implants, round and anatomic implants, all gel types, and all projections. It appears to be purely related to the surface of the implant and not what the implant is filled with or its shape.

What causes BIA-ALCL?

To date, no specific factors have been identified. There are several theories which attempt to explain why this disease is present with textured implants. Many believe that the increased surface area of textured implants allows for a larger number of bacteria around the implant, which forms a biofilm in some patients and can result in chronic inflammation, leading to a large increase of lymphocytes. Other theories suggest these implants create more inflammation because of chronic mechanical irritations or microscopic shedding of silicone from the textured.

We will be contacting individual patients who have received textured breast implants under my care to provide information regarding the risks and symptoms related to BIA-ALCL and to answer the most frequently asked questions. Patients are encouraged to contact my office for more information or to schedule an appointment with me to discuss their concerns.