PSC Uncut

The Truth Regarding Breast Implant-Associated ALCL

The Truth Regarding Breast Implant-Associated ALCL

The headlines were dire following the latest update from the FDA regarding Breast Implant-Associated ALCL: “Breast implants can cause cancer.” Easy enough for journalists to type, the headline guarantees lots of clicks but removes nuance from the equation – an important point for patients and would-be patients who are worried.

In this Plastic Surgery Channel Uncut, board certified plastic surgeons discuss the FDA’s update, what BIA-ALCL actually is, and why patients and the public at large need to put it into perspective.

What is Breast Implant-Associated ALCL?

The condition is often considered a lymphoma, a type of blood cancer caused by lymphocytes. There is a small trend of cases in breast implant patients, enough to cause concern by the FDA. Still, is it actually a lymphoma? The results are still undefined.

“What most likely we’re going to discover is that it’s not actually a lymphoma, but it’s very akin to a skin-type of lymphoma that we have lots and lots of data about, ” explains board certified plastic surgeon Dr. Brian Brzowski. “What they have noticed is that in certain patients who’ve developed fluid accumulations around their implants, there are these abnormal lymphocytes. In certain cases – and it’s been in very, very rare numbers across the world with many millions of women who have breast implants – there actually have been a very isolated number of deaths.”

The distinction between lymphoma and something else is important, as the strategies to combat the illness vary dramatically. Board certified plastic surgeon Dr. Tracy Pfeifer describes the differences in treating BIA-ALCL vs. a typical lymphoma, and why the differences matter.

“When patients come into my office, I like to tell them about the pros and cons of breast implants, and we need to have a discussion about ALCL,” shares Dr. Pfeifer. “But, it’s a little misleading in the sense that the FDA called it a lymphoma whereas most of us, I think, believe it’s probably what we call a lymphoproliferative disorder as opposed to a lymphoma. Because if you have lymphoma, to treat it, you have to have chemotherapy. With a lymphoproliferative situation, we need to remove the implant and take out the capsule and you don’t need chemotherapy.”

The treatment for BIA-ALCL is extremely successful when the condition is caught early. And as Dr. Pfeifer pointed out, standard cancer treatments like chemotherapy are not required to resolve the issue.

Putting the Risk of BIA-ALCL Into Perspective

Regardless of what Breast Implant-Associated ALCL actually is and how it occurs, it’s extremely important for patients to put the risks into perspective. Out of the millions of breast augmentation patients, only a relative handful result in BIA-ALCL. In fact, board certified plastic surgeon Dr. William P. Adams Jr. coauthored a study to define the risk of dying from a breast implant, a useful metric when comparing it to the score other normal life activities.

Breast implant-associated ALCL death risk.

“If you look at the risk of dying from a breast implant, a micromort, it’s 0.4,” explains Dr. Pfeifer. “Here are some common things we do everyday and the risk of dying from them:

  • Skiing one day in the US – 2x
  • Drinking a half a liter of wine – 2.5x
  • Riding a bike for 17 miles – 2.5x
  • Driving a car for 8 hours a day – 40x

“I think that puts it into context and perspective.”

Comparing the Risk of Death of Driving a Car to Breast Implant Associated-ALCL.

To further drill down on the above, breast augmentation patients are 40x more likely to die driving a car 8 hours in one day than they will in their lifetimes of having breast implants. We all drive cars – that’s a significant difference. Only one day of skiing, a seemingly benign activity that millions participate in during the winter months, doubles the chances of death as compared to having a breast implant for decades.

Modern Media Issues

What may be even more detrimental than the risk of extreme illness is the propagation of fear-mongering headlines from media reports following the FDA’s release. The President of the United States likes to joke about the problems with the media, branding them “Fake News.” While sometimes exaggerated in it’s own right, this characterization can apply to the Breast Implant-Associated ALCL discussion as the media tends to build their stories on what will get the most clicks, not what will deliver the most relevant and factual information.

“What I find really remarkable is the day the FDA released their latest update on ALCL, every major network covered that release,” shares Dr. Brzowski. “What they’re not talking about is what this risk really represents in the day-to-day lives of our patients. They should keep in perspective that having a breast implant – even a textured breast implant – is such a long-term non-issue when it comes to their lifespan and health. They really need to look at that in the context of everything that they do on a normal daily basis without ever thinking about it.”

At the end of the day, Breast Implant-Associated ALCL is a real thing – whether or not it’s a true lymphoma. It is a risk, and also a problem that needs to be dealt with immediately should it crop up. That being said, the risks are so incredibly low that patients need not fret, especially when day-to-day activities we all participate in have a far greater risk of death. Breast cancer, after all, affects 1 out of every 8 women.

In any case, this issue is an important reminder that patients need to seek out the best surgeons they can find and have an in-depth discussion during their breast augmentation consultation. Information and evidence are the best protectors against the risk, and any experienced, board certified plastic surgeon will be direct and honest about BIA-ALCL. After all, these kinds of surgeons seek one goal above all others – patient safety.

View Comments (2)


  1. Mark Magnusson

    November 10, 2017 at 5:54 pm

    Perspective, patient education, thoughtful implant selection and antimicrobial strategies. This is a rare and indolent disease that has a visible and noticeable presentation. Appropriate early management of this disease is curable by surgery alone.
    Not a place for panic but thoughtful consideration.

  2. Bruce W. Van Natta, MD

    November 12, 2017 at 10:46 am

    I respectfully disagree with my friends and colleagues on this issue. While not aiming to be alarmist, there are two published reports that are the only data sets with a reliable numerator and denominator for this condition. One is the McGuire report on 410 continued access which when published in January showed 6 cases in 17,656 patients for an incidence of 1:4400. Unfortunately two additional cases have been added since publication leaving the incidence as 1:2900. The Australian/New Zealand Registry report also showed a 1:3800 incidence for the Biocell surface. Given the indolent nature of this disorder, we can anticipate that additional cases will be found which will raise the incidence of BIA-ALCL to a higher frequency than 1:3000-4000. Are there things that can be done to reduce this incidence? Absolutely. Preventing the establishment of the biofilm with gram negative bacteria will most likely prevent this from occurring. This can be achieved using either Betadine of HOCl at the time of implantation. Support of ongoing research is imperative.

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