Breast Implant Associated Lymphoma (BIA-ALCL)

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 surfaced 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.

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.

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 surrounding capsule. Over the last 10 years, four Australian women have died from breast implant-associated lymphoma.

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, the 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?

Medical experts including Dr. Kumar, do not recommend removing 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.

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.