The Surgeon Minute

How to Determine Your BIA-ALCL Risk

How to Determine Your BIA-ALCL Risk

There have been several stories in the National news about breast implants and an association with a rare form of cancer called BIA-ALCL, or Breast Implant Associated Anaplastic Large Cell Lymphoma. While the FDA has determined that there is a possible connection between breast implants, specifically textured implants, and this uncommon cancer of the immune system, the risk factor is still incredibly low. The plastic surgery community, however, believes that this is real and this can be frightening for the many millions of women out there who have implants.

Breast augmentation surgery is still the most popular cosmetic surgical procedure in the world with over 300,000 performed last year in the United States alone. Dr. Caroline Glicksman of Sea Girt, NJ discusses how she approaches this sensitive subject with her patients and why it is imperative that any woman with breast implants be examined regularly by her plastic surgeon.

What is BIA-ALCL?

First of all, Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is not breast cancer. This is something that confuses many patients. ALCL is actually a type of non-Hodgkin’s lymphoma which is a cancer of the immune system. This rare form of blood cancer occurs when your lymphocytes, which are the white blood cells that typically fight off infection, start to grow out of control.

BIA-ALCL - causes.

ALCL can develop in any part of the body, but the two most common areas are the skin and the lymph nodes. With BIA-ALCL, the cancerous cells tend to build up in the scar tissue around the breast implant, not the actual implant itself. However, like any cancer BIA-ALCL can spread to other areas of the body with time.

Are You at Risk for Developing ALCL?

The risk factor for developing BIA-ALCL is incredibly low. It has primarily been associated with textured, not smooth, implants. However, even if you do have textured implants, the lifetime risk of developing BIA-ALCL is estimated to be between 1 in 4,000 and 1 in 30,000. This makes it significantly rarer than breast cancer, which occurs in approximately 1 in 8 women in the US.

Other risks associated with breast implants are far more common, such as capsular contracture, infection, and the need to revise for rupture. But Dr. Glicksman does not like to use analogies such as “‘you are more likely to be struck by lightning’ because everyone perceives risk a little differently”. For her patients with textured implants, Dr. Glicksman believes that their concerns are legitimate and need to be acknowledged. What she does tell her patients is “to be careful as your implants age” and to notify your surgeon and schedule an appointment if you notice any of the following signs or symptoms:

  • swelling around your breast
  • a lump
  • pain in the breast or surrounding tissue
  • changes in the shape of your breast

Schedule an appointment to be assessed in person by your plastic surgeon.

ALCL Discussion Should Be Part of Your Follow Up Exam

Dr. Glicksman does not wait for her patients to ask about ALCL and had made it a practice to schedule routine follow-up exams every two years for all of her breast implant patients. As a plastic surgeon who has used a lot of textured implants over the years because she believes that they were, and still are a wonderful implant, Dr. Glicksman knows that her patients are going to hear the word “textured” and panic.

She has a laminated chart that shows how bacteria may potentially contaminate any implanted device either at the time of insertion, or throughout the years due to bacteria potentially spreading from other sites in the body, to the surface of their implant. Further she explains how patients with a contaminated implant may be most likely to go on to develop capsular contracture, which is still really rare in her practice at about 2 to 4%, or the in the very rare patient, BIA-ALCL. Most importantly she explains to the patient that if there is a problem, she is just a call or email away.

Important to Follow Up Regularly with Your Plastic Surgeon

Dr. Glicksman’s personal belief is: “I am the one that put in their implant. I am the one who should follow it” throughout its lifetime. Making certain to have routine imaging performed if you are over 40, and regularly scheduled annual follow ups with your plastic surgeon are two of the best ways to ensure that any problems with your breast implants, including the rare incidence of BIA-ALCL, are caught as early as possible. And as with any form of cancer, early detection is key. But what if you are a patient:

  • who no longer has a plastic surgeon
  • whose plastic surgeon has retired
  • who has moved and doesn’t have a plastic surgeon in your new state

If you no longer have access to your original plastic surgeon, then you can discuss your BIA-ALCL risk with your gynecologist or primary care physician or seek a referral to a local board certified plastic surgeon.

Finding a BIA-ALCL Expert is Best

Routine follow-up with your plastic surgeon is the best advice that Dr. Glicksman can offer, and she suggests finding a plastic surgeon who is up-to-date on the latest BIA-ALCL research.  Luckily, “there are websites that you can go to such as the FDA, American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgery to seek advice,” explains Dr. Glicksman.

She does not feel that RealSelf or blogs are the best place for sound advice on this topic.  The FDA and plastic surgery societies are far more accurate and up-to-date. This is currently a very active area of research, so look for the knowledgeable plastic surgeons in your area and schedule a follow up exam. This is the best way to ensure the continued good health of your breast implants, shares Glicksman.

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