Understanding the Treatment Options Available for BIA-ALCL

Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon type of cancer that develops in some women with breast implants. It is not the same as breast cancer, instead it occurs in the fluid and scar tissue around the implant. In some cases, if neglected, or not removed properly, it could spread throughout the body. However, it is curable in most patients if diagnosed early and treated properly. Some of its most common symptoms are changes in the size or shape of the breast, hardening, swelling, pain, lumps, or redness. 

These changes may appear years after the implant is placed or may develop earlier, with the earliest case being within a few years. Healthcare providers are not sure why some people with implants occasionally develop BIA-ALCL. One possible cause is abnormal inflammation around the implants that stimulates the immune system. Over time, this leads to cancer of immune cells. When it comes to diagnosis, the specialist will review your medical history and know about the symptoms. He or she may perform physical examinations and schedule tests. For most patients, the first step to successful recovery is explant surgery. There are two types of explant procedure:

• En Bloc:

In en bloc surgery, the capsule and the implant are removed as a unit. The surgery will help get rid of the cancer without the need of other treatments. This is because excision might be incomplete, or it may spill fluid into the breast pocket.

• Total Capsulectomy:

In total capsulectomy, the implant and capsule are removed as separate pieces rather than one unit. The procedure is not recommended as a way to treat BIA-ALCL. It is generally a technique used for capsular contraction. 

The type of treatment will depend on the type of implant, stage and any sign of progression of the cancer, and your health. From the result of the tests, the doctor and the MDT will customize a treatment plan for getting rid of the BIA-ALCL. Whether you undergo an en bloc surgery or chemotherapy and immunotherapy too, ensure that the surgeon is qualified and experienced. Additional therapies such as radiation and the systemic treatment options will come into play if the cancer is difficult to treat.

Everything Topical About BIA-ALCL: Facts, Symptoms & Those at Increased Risk!

Breast cancer is one of the most common cancers found in women, affecting 1 in 8. Various steps are taken to spread awareness about it, but there is much more to know to keep the risks down and to be alert to changes in your breasts. Some women fear it could be caused by deodorant or even breast implants although this has been thoroughtly researched and proved to be incorrect. But the absence of proper guidance leads these myths and others to prevail.

One such misunderstood cancer that can occur in women with breast implants is BIA-ALCL. This is not a breast cancer at all but where lymphocytes (cells from the immune system which are normally found near the scar tissue of the implant) become abnormal and turn cancerous around the implant. According to the recent reports by the FDA, 573 unique cases have been registered worldwide pertaining to breast ALCL. One must also know that these are not at all common, and in fact when looking at all implants, the lifetime risk is probably between 1 in 1000 and 1 in 82,000 depending on which study, and which type of implant is being discussed. Overall in the UK the MHRA reports a rate of 1 in 24,000 implants.

The symptoms include: persistent swelling is the commonest, but it can occur with more subtle changes, or an initial rash or constant itch. A mass in the area of the implant or under the arm should also alert a patient. It can only be confirmed by an expert after full evaluation and diagnosis of the fluid collection, any lump or sometimes even the capsular contracture. Women with textured implants/polyurethane implants are therefore a group with this uncommon risk of getting BIA-ALCL. This still remains a far smaller risk than a woman’s lifetime risk of breast cancer. And although most women with breast implants never have symptoms, the commonest is infact due to the gradual development of a tight scar around the implant, which is termed capsular contraction, ans is usually a benign process.

Myths perpetuate on the internet that BIA-ALCL, which is a are non-Hodgkin’s lymphoma is mostly misunderstood to be a breast cancer. This causes excessive anxiety, as BIA-ALCL can be readily treated if you get in touch with an experienced and professional team at an early stage of getting a chronic swelling, and after diagnostic workup, having complete removal of the implants and the capsule. This is called enbloc capsulectomy and explantation. Have a prior consultation with the experts to know the procedure and risks associated with it before finally having it done. But fear about this uncommon malignancy is spread on social media, driving some women to seek preventative removal of their implants. And futher more, to seek the enbloc capsulectomy of even a normal scar capsule around the implant ‘just in case’. But there can be risks, limitations and consequences of additional more ablative surgery. Women should therefore be mindful of being persuaded into incorrect surgical approaches by the social media keyboard champion (we have all seen these) who may thrive from presenting themselves as the patient’s expert, and having the greatest numbers of followers on their page, but however well meaning they might be, do not see the holistic side of the situation let alone have the necessary professional training. The regulators (such as the FDA and the MHRA) and professional bodies (the ABS, BAAPS and BAPRAS) have updated information on BIA-ALCL and provide a professional source of reference about this to women who have concerns. We recommend those resources and urge anyone with concerns to contact a specialist.