The Surgeon Minute

Risk Reduction for Breast Implant-Associated ALCL

Risk Reduction for Breast Implant-Associated ALCL

Many breast augmentation patients are alarmed by Allergan’s recent recall of their BIOCELL textured breast implants, due to their association with Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), and confused about what they should do. Part of the issue lies with the term recall. This is not like a recall on your car where you could be in danger if you don’t have the issue addressed immediately. Allergan’s recall is simply a call to stop the sale of their BIOCELL implants and remove all inventory from the shelves.

The question remains if you have BIOCELL implants, what should you do? Breast surgery expert Dr. Bruce Van Natta of Indianapolis, IN goes in depth, discussing what he sees as the three options for ALCL risk reduction.

Allergan Recalls BIOCELL Implants

BIA-ALCL is an extremely rare, but real, form of lymphoma that has been found in patients with exclusively textured breast implants. This news set off a flurry of panicked phone calls to plastic surgeons around the world. Patients with BIOCELL and other textured implants wanted to know what they should do to reduce their risk of contracting BIA-ALCL.

Allegan BIOCELL Implant

Many, many expert breast surgeons routinely utilized textured implants, including BIOCELL. Dr. Van Natta is one of them. “Many of my patients have BIOCELL textured implants,” explains Dr. Van Natta. With these patients, he explains to them the difference between a recall on a part for your car (which could put you in danger if not fixed) and the voluntary recall on Allergan’s part.

No one, including the FDA, is recommending that anyone who has these implants should have them removed. This is a really important distinction. 

What is the Risk for BIA-ALCL?

The latest data puts the risk of BIA-ALCL at around 1 in 3,000. To put these numbers into perspective, the lifetime risk of being hit by lightening is also 1 in 3,000, the risk of dying in a house fire is 1 in 1,000, and dying by drowning is 1 in 1,100. These are about three times greater than your risk of developing BIA-ALCL.

Referencing other causes of death is not to minimize BIA-ALCL. Just because the risk is small doesn’t mean someone won’t contract the disease, and it will be from a voluntary decision made in the past. However, it is not necessary to make a rash decision about your implants unless you are experiencing any of the warming signs of ALCL, such as swelling.

See Surgeon Immediately for Swelling

BIA-ALCL, when caught early, is completely treatable. This is why it is so important to stay on top of your breast implant health and take advantage of the yearly follow-up that most plastic surgeons offer their patients. It is one of the best ways for both you and your surgeon to assess any changes to your breast implants.

Breast swelling

If you develop swelling in your breasts or armpits, schedule an appointment with your surgeon to be checked immediately. Swelling is the most common symptom of ALCL. Other symptoms include: 

  • breast enlargement
  • pain in the breasts
  • a lump in the breast and/or armpit
  • sudden asymmetry
  • skin rash
  • hardening of the breasts

Treatment for BIA-ALCL

As discussed, when caught early, ALCL is highly treatable. If you develop any of the common warning signs, schedule an appointment with your breast surgeon immediately. If he or she has retired or you have moved, you can find a board certified plastic surgeon in your area on the American Society of Plastic Surgeons (ASPS) website. The surgeon will remove some of the fluid that is causing the swelling and have it tested. If the test comes back positive for ALCL, the treatment is to remove the breast implant as well as the capsule of scar tissue that forms around the implant. This is the cure for BIA-ALCL. “We have a good treatment for this if you detect it,” explains Dr. Van Natta. 

Two Options for Risk Reduction: Replacement and Removal

If you don’t have any symptoms, you do not need to do anything even if you have BIOCELL textured breast implants. But what if a “wait and see” approach makes you anxious? For Dr. Van Natta, there are a couple options for reducing a patient’s risk of developing ALCL. The first is to swap out the textured implant for a smooth device. For the next 2 years, Allergan is offering their BIOCELL patients smooth, silicone gel breast implants at no cost. You will still have OR and surgical fees, but this is significant savings.

The simple exchange will definitely reduce your ALCL risk, but no one can identify by exactly how much. “Just doing the swap out alone reduces risk but doesn’t eliminate it,” explains Dr. Van Natta. On the other end of the spectrum, he can go in and remove the capsule and the implant. This is the same procedure you would have if you actually had ALCL. This is a bigger operation, however, with a longer recovery.

Again, no patient needs to have their implants removed. If it would ease anxiety, it is an option, but the best surgeons will advise their patients to just monitor their implants for changes. If changes do occur, they will rapidly work to understand the situation and, if BIA-ALCL, begin the process to eliminate it.

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