Lymphomas through Breast Implants – BIA-ALCL?
What is breast implant-associated anaplastic large cell lymphoma?
Undergoing a breast surgery can have a positive impact on somebody’s life. Well over 1,000 of our patients will confirm that. Nevertheless, every operation also carries certain risks. Breast augmentation is no exception.
One of these risks has recently been causing increased discussion: breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Various platforms and medical articles have appeared which we want to summarize here:
What is BIA-ALCL?
BIA-ALCL stands for “Breast implant-associated anaplastic large cell lymphoma”. This is a rare form of cancer that is not to be confused with breast cancer. The World Health Organization (WHO) and the US Food and Drug Administration (FDA) are talking about a possible link between BIA-ALCL and breast implants. However, this is NOT proven. Previous studies, which try to show a connection between implant and lymphoma, are not scientifically reliable due to the limited data available. The FSA currently has just over 600 cases registered. In comparison, there are a number of 35,000,000 implant carriers. When comparing the number of breast implant wearers, the incidence is less than 1 in 50,000. Comparing that every 9th woman has breast cancer, this number is much smaller.
What causes BIA-ALCL?
The exact cause for the formation of BIA-ALCL is unclear. It is thought that the surface structure of the breast implant plays a role: accordingly, implants with a textured surface are more frequently associated with BIA-ALCL than smooth-walled implants. One possible reason for this is that the texture creates a larger surface, which unfortunately also gives bacteria more space. In turn, these bacteria can cause an infection that, in very rare cases, results in BIA-ALCL. Unfortunately, this theory is also shaky, as more than 30 cases of BIA-ALCL were smooth implants.
It is noteworthy that especially implants of the company Allergan are more frequently affected than all other manufacturers and also a higher occurrence in Australia can be seen.
I – Dr. Rolf Bartsch – have used Sebbin implants for many years, which have a very delicate texturing and have been using breast implants from Polytech in Germany for several years now. For this company we use the type: MESMOsensitive® for anatomical implants of type POLYtxt® for round implants. The first type is not aware of a single case of BIA-ALCL worldwide, the second type is a primary case known. It is important to point out that the “texturing” in all Polytech breast implants is produced by a so-called vulcanization and the surface is not “etched” as it is the case with other manufacturers.
This results in a completely different surface for the textured Polytech breast implants than for the BIA-ALCL most affected Allergan Biocell breast implants:
Manufacturer Surface Roughness (Sa/μm)
acc. Barr et al. 2017/ Jones et al. 2018/ University of Darmstadt
Allergan Biocell 80 / 92 / –
Polytech POLYtxt® 42 / 59 / 43
Polytech MESMOsensitive® – / – / 24
What are the symptoms of BIA-ALCL?
BIA-ALCL mostly occurs in the tissue surrounding the breast implant, but may spread to other areas of the body, including: on the lymph nodes.
Common symptoms include:
- Persistent swelling or pain in the area of the breast implants, although the surgery was years ago
- Collection of fluid around the breast implant
- Encapsulation in the form of scar tissue around the breast implant or as a capsule under the skin
This does not mean, however, that with every capsular contracture a BIA-ALCL is to be considered.
How is BIA-ALCL diagnosed?
Half of all reported cases of BIA-ALCL were reported mostly within 7 to 8 years after the onset of breast implants. If a doctor suspects BIA-ALCL, various tests are performed to rule out other causes of the symptoms. For example, the doctor can perform a biopsy of the tissue or an ultrasound-guided secretion suction. Science has made tremendous progress in recent years and established appropriate diagnostic standards. We can organize this special examination (examination of the secretions on CD 30 and ALK1) within a short time for our patients at the University Hospital in the AKH Vienna.
How is BIA-ALCL handled?
If BIA-ALCL is diagnosed early, it is sufficient to remove the breast implants and the surrounding capsule. In a second-stage diagnosis of BIA-ALCL, in addition to the removal of the breast implants and the associated capsule, chemotherapy will be used to stop the disease. This type of lymphoma has a very gradual progression and can be treated very well.
BIA-ALCL is a very rare disease believed to be related to heavily textured breast implants. Symptoms that should lead to further examination are severe general malaise and sudden swelling of one or both breasts with tissue fluid formation. A prophylactic change of breast implants or even removal without symptoms is NOT recommended by us and also by the FDA.
The recent bans on some textured implants on the French market (April 2019) lack any scientific basis and are likely to bring judicial follow-up.
I would like to clarify you in a personal conversation about more details and will continue to report here about possible developments on this topic. Due to the current scientific situation, we are convinced that our Polytech® breast implants are among the best in the world and that these products in particular make the risk of getting ALCL more than minor.