In short: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare type of lymphoma that develops in the scar tissue or fluid around a breast implant, mostly textured implants. It usually shows as swelling from fluid around the implant years after surgery. When found early, it is usually treated by removing the implant and the complete surrounding capsule.
- What is breast implant associated…
- Who can get breast implant…
- BIA-ALCL in Australia
- How is breast implant associated…
- What is the treatment and prognosis…
- How do I spot the symptoms?
- What if I have implants but no…
- Should my implants be removed even…
- Reducing risk and myths
- BIA-ALCL vs breast implant illness
- When to have a breast implant checked
- Questions
What is breast implant associated cancer?
Breast implant associated cancer, which is also known as breast implant associated anaplastic large cell lymphoma (BIA-ALCL), is a rare cancer of the immune system. It is not breast cancer, which forms from cells in the breast, but instead a cancer that grows in the fluid and scar tissue that forms around a breast implant. Less commonly, BIA-ALCL can take the form of a lump in the breast or a lump in the armpit.
BIA-ALCL has been known to occur as soon as one year after the operation and as late as 37 years after the operation. The average time to diagnosis is within 8 years of the operation.
Who can get breast implant associated cancer?
All reported cases of breast implant associated cancer in Australia involve patients who have had a textured implant at some point in their life. Based on current evidence, experts do not think breast implant associated cancer is related to either the contents (saline/silicone) or shape (round/teardrop) of the implant.
Breast implant associated cancer is rare. The recent review by the TGA has found between one in 2,500 and one in 25,000 people with breast implants are diagnosed with the condition in Australia; based on confirmed cases of BIA-ALCL where only one brand of implant had been used. The risk of developing BIA-ALCL increases with increasing texturing of the implant. Implants which have a smooth surface have not been associated with BIA-ALCL. Breast implant associated cancer can occur after either reconstruction or augmentation surgery, with 95% of cases occurring between three and 14 years after the insertion of an implant.
BIA-ALCL in Australia: the numbers
BIA-ALCL is rare. NSW Health (2025) reports 150 confirmed cases in Australia. The estimated risk ranges from about 1 in 1,800 to 1 in 18,000 women, depending on the type of implant. Every confirmed Australian case has involved a textured implant. No case has involved a smooth (Grade 1) implant.
| Implant surface | Examples | Relative risk |
|---|---|---|
| Smooth (Grade 1) | Most implants used in Australia today | No Australian cases reported |
| Lightly textured (micro-textured) | Implants with a fine surface texture | Low |
| Heavily textured (macro-textured) and polyurethane-coated | Including the Allergan Biocell range, recalled in 2019 | Highest of all implant types |
In 2019 the TGA acted on textured implants. Allergan recalled its macro-textured Biocell implants and tissue expanders in July, and in October the TGA suspended a further group of textured implants from supply. The TGA also advised that women with these implants who have no symptoms do not need to have them removed. If you are not sure which implants you have, your implant card, your operation report or the Australian Breast Device Registry can help. Dr Kumar can also help you find out.
How is breast implant associated cancer diagnosed?
If you develop swelling of an implanted breast Dr Kumar will send you for an ultrasound scan to see if this is due to a fluid collection. If fluid is present it will be removed and sent to the laboratory for analysis. Most fluid collections are not due to BIA-ALCL, but the laboratory test will be able to tell for sure. The fluid is tested for a marker called CD30, which BIA-ALCL cells carry, along with other tests to confirm the diagnosis.
If confirmed, Dr Kumar may also order an MRI scan or CT scan to assess the extent of local growth or distant spread of the cancer. Other tests such as a PET scan may be also used to assess spread.
A mammogram will check for breast cancer, but is not useful for detecting BIA-ALCL.
What is the treatment and prognosis for breast implant associated cancer?
It is usual that care is provided by a multi-disciplinary team. A treatment plan may be developed with advice from a blood disease specialist with experience in lymphoma, a cancer specialist, and a surgeon with breast implant experience.
In about 80% of cases, the disease is detected in the early stage, with cancer cells found only in the fluid surrounding the implant. Most of these cases are cured by removal of the implant and the whole surrounding capsule, known as en bloc capsulectomy. Four deaths from BIA-ALCL had been reported in Australia by 2019. When the disease has spread beyond the capsule or into lymph nodes, treatment is more involved and the outlook is less certain, which is why prompt assessment of any late swelling matters.
Usually, both implants are removed even if breast implant-associated ALCL has only occurred in one breast. This is because there is a small but real risk that breast implant-associated ALCL can develop in the opposite breast. If there is a solid lump or the cancer has spread, you may require additional treatment such as chemotherapy, radiotherapy or additional surgery. Follow up monitoring may require additional CT scans.
How do I spot the symptoms?
It is important to know the symptoms of breast implant associated cancer. The most common symptom is swelling of a breast caused by fluid build-up around the implant, but in some cases it may appear as a lump in the breast or armpit.
As this is a rare disease, changes in your breast are unlikely to be breast implant associated cancer. For example, swelling immediately after your breast implant surgery is normal. But you should raise all concerns with Dr Kumar, including the possibility of breast implant associated cancer. If you are unable to come back to see Dr Kumar (moved interstate etc) then you should still contact us and also see your GP for referral to another surgeon.
What if I have implants but no symptoms at all?
Get to know the normal look and feel of your breasts. Self-examine your breasts regularly, such as in the bath or shower, and include your armpits and up to your collarbone.
If you think there are any changes, or if you have any concerns, see Dr Kumar
Discuss with Dr Kumar how often in your case there should be monitoring over the longer-term.
Should my implants be removed even though I have no symptoms?
Current medical advice, including Dr Kumar’s, is not to remove your breast implants if you do not have symptoms of BIA- ALCL, even if your implants are no longer supplied in Australia. This is because BIA- ALCL is a rare cancer with excellent cure rates if it is detected early.
The risk of developing BIA- ALCL is lower than the risks associated with an anaesthetic and surgery. The complication rate of revision surgery involving implant removal or replacement is also higher with each revision procedure.
Generally, breast implants are not lifetime devices, regardless of breast implant associated cancer. Typically they are removed after 10-15 years. The longer you have the implant, the more likely it will need to be removed. Common reasons for removal are contracture (hard or painful implants) or movement of the implant.
Breast implant associated cancer is rare, but the risk is higher with certain types of breast implants. If you do not remember whether your previously inserted implants are smooth or textured, or what brand they are, your surgeon or the clinic that holds your operation record should be able to advise you on these details.
It is best to discuss with Dr Kumar what he would recommend in their clinical opinion given the type of implant you have and the benefits versus risks of removal of implants in a healthy person with no symptoms. You can also discuss a plan for regular check ups. You can seek a second opinion to help you decide on options. Regardless of the brand or texture of the implant, or if you have had your implants removed, you should regularly carry out breast self-examination and seek review by your general practitioner if you have any concerns or notice any changes in your breasts.
Reducing your risk, and common myths
The main factor linked to BIA-ALCL is the implant surface, not what the implant is filled with. Silicone and saline implants both come in smooth and textured versions, and the risk follows the texture. Choosing a smooth implant, and knowing exactly which implant you have, are the two most useful steps. Careful sterile technique during surgery is also thought to matter, because long-term inflammation around the implant is one of the proposed causes.
| Myth | Fact |
|---|---|
| All breast implants cause cancer | BIA-ALCL is rare and linked almost entirely to textured implants. No Australian case has involved a smooth implant. |
| It appears soon after surgery | Most cases appear between three and 14 years after the implant was placed, on average about eight years. |
| Textured implants should always be removed | Australian guidance does not recommend removing implants that are causing no symptoms. Regular checks and prompt assessment of any change are advised. |
| BIA-ALCL cannot be treated | When found early, most cases are cured by removing the implant and the whole capsule. |
BIA-ALCL, breast implant illness and other rare cancers
BIA-ALCL is not breast implant illness. BIA-ALCL is a defined cancer, with a laboratory test and a clear treatment. Breast implant illness describes whole-body symptoms such as fatigue, brain fog and joint pain, and it has no test and no proven cause. Read more about breast implant illness.
BIA-SCC (breast implant-associated squamous cell carcinoma) and some other lymphomas have been reported very rarely around both smooth and textured implants, mainly overseas. Like BIA-ALCL, they usually cause swelling, pain or a lump many years after surgery. They are assessed in the same way, with imaging and laboratory testing, and treated by removing the implant and the whole capsule.
When to have a breast implant checked
| Change | What it may mean | What to do |
|---|---|---|
| Swelling of one breast a year or more after surgery | Fluid around the implant, which has several causes, including BIA-ALCL | See your GP or surgeon for an ultrasound and fluid testing |
| A new lump in the breast or armpit | Needs assessment | See your GP or surgeon |
| No symptoms | Australian guidance does not recommend removing implants that are causing no problems solely because of BIA-ALCL risk | Continue regular checks |
Can I get Medicare benefits for tests and treatment of breast implant associated cancer?
Even if your breast implant procedure did not attract a Medicare benefit at time of implantation, services for investigation and treatment of breast implant associated cancer, as with any other cancer, are eligible for payment of Medicare benefits. In addition to benefits for diagnostic imaging and pathology services, there is also a Medicare benefit specific for magnetic resonance imaging (MRI) investigation of patients diagnosed with BIA-ALCL (MBS item 63547).
A Medicare benefit is payable under MBS item 45551 for removal of each breast implant and its surrounding capsule. Other MBS items are available for lymph node procedures and for other types of breast surgery if required.
Dr Kumar will choose the appropriate items depending on the procedure that is clinically necessary for you.
For more information on BIA-ALCL you can visit the ASAPS website, the ASPS website as well as the TGA website.
Risks and Considerations
Before considering any plastic surgical procedure performed by Dr Kumar, it’s crucial to be aware of potential risks and complications. While Dr Kumar and his team prioritize safety and strive for successful outcomes, it’s important to understand that all surgeries come with inherent risks. Below is a general overview of some of the potential risks associated with plastic surgical procedures. For a more comprehensive understanding of risks specific to the procedure you’re considering, we invite you to visit the procedure dedicated page on Dr Kumar’s website.
Recovery, week by week
| When | What to expect |
|---|---|
| Day of surgery | Implant and capsule removal is usually a day case. Your plan may differ if further treatment is needed. |
| Weeks 1 to 2 | Time off work. Soreness, swelling and tightness across the chest. Walk daily, and avoid lifting or reaching overhead. First review with Dr Kumar and his nurses at about one week. |
| Weeks 2 to 6 | Most patients return to work from about two weeks, then gradually resume most everyday activities over the next four weeks, depending on how physical the activity is. No heavy lifting or straining, and drive only once you can do so comfortably and safely. The Prineo and Micropore dressings come off at six weeks, and the compression garment is worn for six weeks. |
| Weeks 6 to 12 | After your six-week review, exercise and more physical work are built up progressively. Most patients are cleared for full activity at the 12-week review. |
| 3 to 12 months | Swelling settles and the scars mature. Reviews at 6 months and 12 months. |
Results
Surgical photographs are restricted to viewers aged 18 and over. The outcomes shown in any photograph are relevant only to the patient pictured, and individual results will vary. You can view the implant removal and revision gallery.
Where Dr Kumar operates
Consultations are held at Westmead, Penrith and Orange. If you live a long way from Sydney, you can send photos to Dr Kumar’s team before your first appointment.
Day-case procedures are performed at Somerset Private Hospital in Kingswood or at Westmead Private Hospital, an accredited Ramsay Health Care hospital.
Dr Kumar’s nurses also work on the wards at Westmead Private Hospital. The nurses who prepare you for surgery are the same ones who look after you at every post-operative review.
Common questions
Should I have my implants removed if I have no symptoms?
Australian guidance does not recommend removing implants that are causing no problems solely because of BIA-ALCL risk. Regular checks and prompt assessment of any change are advised.
What are the signs of BIA-ALCL?
The most common sign is swelling of one breast from fluid around the implant, usually years after surgery. A lump in the breast or armpit can also occur.
How is BIA-ALCL diagnosed?
With an ultrasound and testing of any fluid collected from around the implant.
How is BIA-ALCL treated?
When found early, it is usually treated by removing the implant and the complete capsule around it. Some patients need further treatment.
Do I need a GP referral?
Yes. A GP referral is required to see Dr Kumar, and it is also needed for the Medicare rebate on your consultation.
What does the consultation cost?
Dr Kumar’s initial consultation fee is $400, with a Medicare rebate of approximately $88 with a GP referral. Surgical fees are quoted individually after consultation.
Where is the surgery performed?
Day-case procedures are performed at Somerset Private Hospital in Kingswood or at Westmead Private Hospital. Consultations are held at Westmead, Penrith and Orange.
Which implants are associated with BIA-ALCL?
Most cases have been linked to textured implants.
How common is BIA-ALCL in Australia?
It is rare. NSW Health reports 150 confirmed cases in Australia, with an estimated risk of about 1 in 1,800 to 1 in 18,000 depending on the implant type. All Australian cases have involved textured implants.
Can BIA-ALCL happen with smooth implants?
No confirmed Australian case has involved a smooth (Grade 1) implant. The risk rises with the degree of texturing of the implant surface.
Is BIA-ALCL breast cancer?
No. It is a lymphoma, a cancer of the immune system, that forms in the fluid or scar capsule around the implant. It is not a cancer of the breast tissue itself.
Is BIA-ALCL curable?
When it is found early and is confined to the fluid or capsule, most cases are cured by removing the implant and the whole capsule. More advanced disease may also need chemotherapy or radiotherapy.
Does it matter whether my implants are silicone or saline?
For BIA-ALCL, no. The risk is linked to the texture of the implant surface, not to the filling. Silicone and saline implants are both available with smooth or textured surfaces.
Patient information sheets
Printable information sheets for anyone with breast implants, written by Dr Kumar and given to his breast augmentation patients. Download, print or keep them with your implant details.
Talk it through with Dr Kumar
If you have implants and have noticed swelling or a change, arrange an assessment. Dr Kumar consults in Westmead, Penrith and Orange, and a GP referral is required. You can also download a procedure guide first.
This page is intended as general information and is not a substitute for individual medical advice. All surgery carries risk, and individual results will vary. Surgical photographs on this website are intended for viewers aged 18 and over. Read more about the risks of surgery here.
Dr Rohit Kumar (MED0001630444) Registered medical practitioner, specialist plastic surgeon (specialist registration in surgery – plastic surgery).
