What is BIA-ALCL?

Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is not breast cancer—it is a unique type of non-Hodgkin’s lymphoma (cancer of the immune system). 

ALCL in women with breast implants

We are here to provide and share information on BIA-ALCL in real time. We are not doctors. This site is not meant to offer individualized medical advice. We recommend that you take the information you find here and share it with your doctors, so that you can get the individualized medical advice you need.

Risk Factors

Being at risk for BIA-ALCL does not mean you will get BIA ALCL. It just means that there is a chance you will get it.You are at risk of developing BIA-ALCL if you have (or had) breast implants or breast implant expanders. Your risk of developing BIA-ALCL is significantly higher if you have (or had) textured implants or textured
implant expanders. To date, there is no confirmed case of BIA-ALCL occurring in someone who never had textured implants or textured implant expanders at some point in their medical history. More information on risk factors and risk estimates will be coming soon.

Symptoms

Knowing the signs and symptoms of BIA-ALCL can help early diagnosis and saves lives.

BIA-ALCL involves the proliferation of lymphoma cells in or around a breast implant scar capsule.  This proliferation will usually also involve the development of fluid around the implant and/or an increase in the thickness of the scar capsule surrounding the implant.  As a result of these changes, the symptoms of BIA-ALCL can include but are not limited to the following:

  • A change in breast shape or implant shape;
  • An increase in breast size;
  • The development of or an increase in breast asymmetry;
  • A change in the way the breast feels such as an increase in firmness;
  • Pain in or around the breast;
  • The development of a lump or lumps in or around the breast or under the armpit;
  • Swollen lymph nodes;
  • Itching or redness of the skin on or near the breast;
  • Lesions on the skin on or near the breast;
  • Fluid around the implant seen on imaging such as ultrasound and/or MRI;
  • Masses or areas of increased thickness of the scar capsule around the breast implant as seen on imaging;
  • Fever;
  • Severe fatigue; and
  • Nightsweats.

It is important to know that some of the symptoms of BIA-ALCL are similar to other conditions, including those of other implant-related conditions such as capsular contracture.  If such symptoms are present, BIA-ALCL can only be ruled out by having fluid and/or tissues examined by a pathologist following the NCCN guideline testing protocols.

For more information, download the What Patients Need to Know brochure.

Screening

Please note, we have no financial relationships with any doctors and cannot and do not make any representations about the quality of any services a specific doctor might provide.  Links to and discussions regarding specific physician’s services and opinions are for informational/educational purposes only.

Below is a link to a very informative video/blog on BIA-ALCL evaluation and testing. The blog makes several points that should be useful to women seeking screening/testing for BIA-ALCL.

https://bardcancercenter.blogspot.com/2018/08/cancer-alert-breast-implant-associated.html
  • Any amount of fluid (no matter how small) could be a sign of BIA-ALCL and should be aspirated and tested for BIA-ALCL.      
  • The appearance of the fluid on ultrasound can provide a clue as to how likely it is to be malignant. So an experienced sonographer can look for more suspicious appearing pockets of fluid to improve the accuracy of the aspiration fluid test if an initial test is negative.     
  • Special probes and scanning the patient in different positions (sitting up vs. laying down) can allow the sonographer to detect fluid behind an implant that might otherwise be hidden or missed.       
  • Thoroughness, skill, and proper equipment will give the most complete evaluation for BIA-ALCL. In fact, more sophisticated equipment from Israel may soon be available to improve diagnostic capabilities.     
  • An MRI and an ultrasound can be used to identify masses or thickened areas around an implant that can also be tested before explant. The absence of blood flow in these masses or thickened areas decreases the likelihood that they are malignant however the best protocol is still to biopsy them.         
  • Ultrasound guided biopsies can be done of masses, fluid, and thickened areas of the capsule without rupturing the implant.         
  • Dr. Bard does mention that BIA-ALCL can occur in women with smooth implants. I have not received any information to suggest that he has knowledge that such smooth cases are “smooth only” cases as opposed to cases where a woman with smooth implants had a prior history of textured implants or textured expanders. If I learn that Dr. Bard does indeed have knowledge of a “smooth only” confirmed case of BIA-ALCL, I will post that information immediately.

Statistics

Since the initial case report in 1997, ASPS now recognizes approximately 400 both suspected and confirmed cases in the US and a total of 1,227 worldwide as of August 2022. Additional statistics and information about BIA-ALCL can be found on the ASPS website. There are 36 known deaths worldwide from BIA-ALCL.

The slide below is not as up-to-date as the  ASPS website.  However, the slide does provide some useful information on the number of cases of BIA-ALCL reported in specific countries.

The FDA is requesting all confirmed cases of BIA-ALCL, be reported with as much detail as possible, through FDA’s MedWatch Program.

International links to Regulators and Plastic Surgery Associations

 

Obstacles

More information about the obstacles with BIA-ALCL is coming soon. 

Support

You are not alone. After a BIA-ALCL diagnosis, it’s important to find credible information and support. With unique types of cancer, sometimes finding resources can be difficult, but we are here to help and provide information in real time.