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How to Evaluate Your Risk for This Rare Type of Lymphoma

If you have textured breast implants, you could be at risk for breast implant–associated anaplastic large cell lymphoma (BIA-ALCL). BIA-ALCL is a cancer of the immune system and is a type of non-Hodgkin’s lymphoma—it is not breast cancer. People who have breast implants with the most textured surface have the highest risk.

“It’s not clear exactly how these implants cause BIA-ALCL,” said Michel Saint-Cyr, MD, a plastic surgeon at Banner MD Anderson Cancer Center in Arizona. One theory is that the rough, sandpaper-like surface of textured breast implants might cause chronic inflammation that leads to BIA-ALCL.

Another theory is that the larger surface area of a textured implant traps more bacteria, creating what’s called a biofilm—a colony of microbes that stick to each other and to the implant’s surface. This biofilm might cause inflammation and lead to BIA-ALCL.

BIA-ALCL is usually found in the scar tissue and fluid near the implant, but in some cases, it can spread throughout the body.

Who is at risk for BIA-ALCL?

The risk of developing BIA-ALCL is low, but this cancer is serious and can lead to death, especially if it’s not treated quickly.

You’re at risk if you’ve had textured breast implants placed, either for breast reconstruction or for cosmetic breast enhancement, and your risk increases the longer you’ve had the implants in place. Most people with BIA-ALCL are diagnosed from 7.5 to 11 years after their implants are inserted.

Whether a breast implant is filled with saline or silicone doesn’t seem to affect your risk of developing BIA-ALCL, but there also is no data available from large, well-designed studies examining this risk, Dr. Saint-Cyr said.

What are the symptoms of BIA-ALCL?

Symptoms include breast swelling or redness not associated with an infection, breast pain, a lump in the breast or the area of the breast implant or spontaneous fluid collection in the breast pocket which can sometimes happen after routine imaging. “These symptoms may occur well after the surgical incision has healed, often years after the implant was placed,” Dr. Saint-Cyr said. Other, less common symptoms include enlarged lymph nodes, skin rash, fever and weight loss.

If you notice one or more of these symptoms, it does not mean you have BIA-ALCL. However, it is important you talk to your health care provider. Your doctor can order an ultrasound or MRI to see if fluid is collecting around the implant and can refer you to a specialist who diagnoses and treats BIA-ALCL. If there’s fluid or a lump present, it can be tested for BIA-ALCL.

How can BIA-ALCL be treated?

Treatment usually involves surgery to remove the implant and the scar tissue that surrounds it. “Even if one implant is affected, both implants should be removed,” Dr. Saint-Cyr said. Any suspicious masses or lymph nodes should be biopsied or removed as well. Some people also need chemotherapy, radiation therapy or stem cell transplant therapy.

“For people who receive appropriate, timely treatment, the prognosis is very good,” Dr. Saint-Cyr said. “Research shows 93% of patients are still disease-free three years following their treatment.”

What if I have textured breast implants but I don’t have symptoms?

The FDA does not recommend removing textured breast implants or expanders if you have no symptoms. “The risk of developing BIA-ALCL is rare, but you should monitor your breasts with regular examinations,” Dr. Saint-Cyr said. Contact your doctor if you notice:

  • Persistent breast swelling or a mass near the breast implant
  • Pain near the breast implant
  • Any changes in the areas around the breast implant

The bottom line

BIA-ALCL is a rare but serious type of cancer that can affect people who have textured breast implants. If you notice swelling, pain or changes in your breast and you have textured implants, talk to a health care provider. Reach out to Banner Health if you need to connect with a doctor.

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